Pharmacy

Aetna Better Health’s formulary drug list

The Formulary is a list of drugs chosen by Aetna Better Health and a team of doctors and pharmacists that are generally covered under the plan as long as they are medically necessary. Prescriptions must be filled at an Aetna Better Health network pharmacy, and other plan rules must be followed.

Please review the Formulary for any restrictions or recommendations regarding prescription drugs before prescribing a medication to an Aetna Better Health patient.

You can download the Formulary or search the list inside the provider web portal.

Visit Pharmacy Provider Search to view all the Aetna Better Health pharmacy providers. 

Network update effective September 1, 2013

Aetna Better Health wants to let you know of a change to our prescription drug network. As of September 1, 2013, Walgreens will be added back into our network. In addition to your local Walgreens pharmacies, we have the following drugstores in our network. They are all ready to serve you.

  • CVS
  • Target
  • Wal-Mart
  • Dominick’s Pharmacy
  • Jewel-Osco Pharmacy

The step therapy program requires certain first-line drugs, such as generic drugs or formulary brand drugs, to be prescribed prior to approval of specific second-line drugs. Drugs having step therapy are identified on the formulary with “STEP.”

Certain drugs on the formulary have quantity limits and are identified on the formulary with “QLL” The QLLs are established based on FDA-approved dosing levels and on national established/recognized guidelines pertaining to the treatment and management of the diagnosis it is being used to treat.

To request an override for the step therapy and/or quantity limit, please fax the correct  pharmacy prior authorization request form and any supporting medical records that will assist with the review of the request to 1-855-684-5250.

CVS Caremark Specialty Pharmacy is a pharmacy that offers medications for a variety of conditions, such as cancer, hemophilia, immune deficiency, multiple sclerosis and rheumatoid arthritis, which are not often available at local pharmacies. Specialty medications require service authorization before they can be filled and delivered. Providers can call 1-866-212-2851 to request service authorization, or complete the applicable service authorization form and fax to 1-855-684-5250.

Specialty medications can be delivered to the provider’s office, member’s home, or other location as requested.

Mail order prescriptions

If your members take medicine for an ongoing health condition, they can have their medicines mailed to their home. Aetna Better Health works with a company called CVS Caremark, to give them this service, which they can get at no cost.

If they choose this option, their medicine comes right to their door. They can schedule their refills Here are some other features of home delivery:

  • Pharmacists check each order for safety.
  • They can order refills by mail, by phone, online, or they can sign up for automatic refills.
  • They can talk with pharmacists by phone at any time 24 hours a day, 7 days a week.

They can sign up for this service in one of three ways:

  • CVS Caremark toll free at 1-855-271-6603 Monday to Friday between 8 a.m. and 8 p.m., Eastern Time. They will help your member sign up for home delivery. As their provider, CVS will call you to get the prescription.
  • Go to www2.caremark.com/readyfill/. Then log in and sign up for ReadyFill. Again CVS Caremark will contact you, the provider, to get a prescription.
  • Your patient may ask to write a prescription for a 90 day supply with up to one year of refills. They will then complete the mail order services form and mail it to CVS Caremark along with the prescription.

CVS Caremark Mail Order Service Form English / Spanish

Aetna Better Health also covers certain over-the-counter drugs if they are on our list. Some of these may have rules about whether they will be covered. If the rules for that drug are met, Aetna Better Health will cover the drug. Like other drugs, over-the-counter drugs must have a prescriptionfor them to be covered at no cost to our members.