Part D prescription drugs

As a contracted provider in the Aetna network, you will receive a copy of the Preferred Drug List (PDL) that is updated inside of the Provider Manual annually.

For additional information and guidelines about the PDL, please review Chapter 12 of your Provider Manual. There also are several forms available below to assist you with a variety of needs.

What is the Formulary?

The formulary is a list of drugs selected in consultation with a team of health care providers. The drugs we chose represent the prescription therapies believed to be a necessary part of a quality treatment program. Aetna will generally cover the drugs listed on our formulary as long as the drug is medically necessary.

The formulary is continuously under review, and as changes occur, the version on the website is updated.

For a drug that is not on the List of Covered Drugs (formulary), a statement must be provided documenting trial and failure of the formulary medications or a medical reason why the formulary medications cannot be used.

For information on benefits, view the member's Summary of benefits. For more detailed information on prescription drug coverage, please review the members Evidence of Coverage - English and other member materials, or contact Member Services at 1-866-600-2139 (8AM to 8PM EST, 7 days a week ).

Verify member eligibility for low-income subsidy

Part D Information

 

We are committed to making sure our providers receive the best possible information, and the latest technology and tools available.

We have partnered with CoverMyMeds® and SureScripts to provide you a new way to request a pharmacy prior authorization through the implementation of Electronic Prior Authorization (ePA) program.

With Electronic Prior Authorization (ePA), you can look forward to:

  • Time saving
    • Decreasing paperwork, phone calls and faxes for requests for prior authorization
  • Quicker Determinations
    • Reduces average wait times, resolution often within minutes
  • Accommodating & Secure
  • HIPAA compliant via electronically submitted requestsGetting started is easy. Choose ways to enroll:

No cost required! Let us help get you started!

Aetna Better Health Premier Plan MMAI

Rx BIN: 610502

PCN: MEDDAET

Rx Group: RXAETD

Some medically administered Part B drugs may have special requirements or coverage limits. This is called utilization management. Please click the link below to find the information you need:

Requirements for Medicare Part B Drugs