Pharmacy

Learn about your pharmacy benefits

Getting your prescriptions

If you need medicine, please ask your provider to choose from our Preferred Drug List (PDL).

• Take your prescription to a pharmacy that’s in our network.
• Show your Aetna Better Health of Kansas member ID card at the pharmacy.

Sometimes your provider will want to give you a drug that is not on our list or that is a brand name drug. Your provider may feel you need a medicine that is not on our list because you can’t take any other drugs except the one prescribed. Your provider can request approval from us. Your provider knows how to do this.

Find a network pharmacy

Check the list of network pharmacies and look for one in your area. You can also search for a network pharmacy on the secure web portal and the free mobile app.  If you need help, please call Member Services at 1-855-221-5656, (TTY: 711). They’ll be glad to help you find a network pharmacy near you.

Always remember to fill your prescription at a network pharmacy. Your prescriptions won’t be covered at other pharmacies. If you are traveling and have an emergency need for a medication and are outside of Kansas, you will need to pay for the medication and submit the paid receipt with the prescription information to Aetna.

Formulary drug list

The formulary is a full list of covered drugs, which includes the Preferred Drug List (PDL).

You can also view the preferred drug list via our formulary search tool. Searches can be performed by drug name or by drug class. The tool will provide formulary status, generic alternatives and if there are any clinical edits (Prior Authorization, Quantity Limits, and Age Limits etc.).

Please note:  The preferred glucose meters and test strips are J&J One Touch products and the preferred pen needles are BD products.

Updates are made regularly to the KanCare preferred drug list and can be viewed below and through the formulary search tool. Formulary changes to identify include:

• Addition/removal of a drug from the formulary
• Addition/removal of quantity limits
• Addition/removal of prior authorization requirements

If you have questions, please call Member Services at 1-855-221-5656, (TTY: 711). Have a list of your prescriptions ready when you call. Ask us to look up your medicines to see if they’re on the list.

Medicines not on the Preferred Drug List (PDL)

If your medicine is not on the Preferred Drug List or is a brand name drug, there are some things you can do.

• Ask your provider for a similar drug that is on the list.
• Ask your provider to seek “exception request” (pre-approval) from Aetna Better Health of Kansas to cover this medicine. Your provider knows how to do this.

Over-the-counter drugs

Aetna Better Health also covers certain over-the-counter drugs. Some are covered, under certain rules. 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 prescription from a provider for them to be covered at no cost to you.

You can look to see if your over-the-counter medicines are on the preferred drug list. You can also check with Member Services at 1-855-221-5656, (TTY: 711). When you call, have a list of your over-the-counter medicines ready. Ask the representative to look up your medicines to see if they’re on the list.

Mail Order Prescriptions

If you take medicine for an ongoing health condition, you can have them mailed to your home. Aetna Better Health uses CVS Caremark to give you this service. It is available at no cost to you.

If you choose this option, your medicine comes right to your home. You can schedule your refills. You ask your pharmacists questions. Here are some other features of home delivery:

• Pharmacists check each order for safety.
• You can order refills by mail, by phone, online, or you can sign up for automatic refills.
• You can talk with pharmacists by phone.

It’s easy to start using mail service
Choose ONE of the following ways to use mail service for a medicine that you take on an ongoing basis:

• Call the CVS Caremark at 1-855-271-6603, (TTY: 711), Monday to Friday between 8 a.m. and 5 p.m. They will help you sign up for home delivery.

When you call, be sure to have:

• Your Member ID card
• Your doctor’s first and last name and phone number
• Your mailing address.

Go to our secure member portal and go to Tasks and then Pharmacy Services. Click on the CVS link to go to Caremark.com.   Click on start “mail service” to print off the mail order form. You can contact CVS at 1-855-271-6603.

• Fill out and send a mail service order form. If you already have a prescription, you can send it to CVS Caremark with a completed mail service order form. If you don’t have an order form, you can request one by calling Member Services at 1-855-221-5656, (TTY: 711). You can also download it from the secure member portal. Go to Tasks and then Pharmacy Services. Click on the CVS link to go to Caremark.com.  Click on start “mail service” to print off the mail order form.

Have the following information with you when you complete the form:

• Your Member ID card
• Your complete mailing address, including ZIP code
• Your doctor’s first and last name and phone number
• A list of your allergies and other health conditions

Your original prescription from your doctor. 

CVS Mail-Order Service Form (English|Spanish)

Refills

Your medicine bottle label says how many refills you can have. If your provider hasn’t ordered refills, and you think you need one, you must call him or her a few days before your medicine runs out. When you call, ask your provider about getting a refill. He or she may want to see you first.

Medication recalls

Need information about medication recalls?  Just call the U.S. Food and Drug Administration (FDA) at 1-888-463-6332.  Or visit the drug recalls page on the FDA website.