Pharmacy

Formulary drug list

The formulary is a list of drugs chosen by Aetna Better Health of Kentucky and a team of doctors and pharmacists. Drugs on this list are generally covered under the plan as long as they are medically necessary. Members must fill their prescriptions at an Aetna Better Health of Kentucky network pharmacy and follow other plan rules.

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

You can download the formulary. You can also view a list of this month's formulary updates.

You now have the ability to search for drugs using our new 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, Age Limits etc).

Common Preferred Drug List (PDL)

Drug Recall - Immediate Action Needed

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

Pharmacy PA Guidelines for pharmacy prior authorization for:

CVS Health Specialty Pharmacy is a pharmacy that offers medications for a variety of conditions, such as cancer, hemophilia, immune deficiency, multiple sclerosis and rheumatoid arthritis. These specialty medications are not often available at local pharmacies. Specialty medications require service authorization before they can be filled and delivered. Providers can call 1-866-814-5506 to request prior authorization, or complete the applicable prior authorization form and fax to 1-855-799-2550.

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

The step therapy program requires that you prescribe certain first-line drugs, either generic drugs or formulary brand drugs, before you can prescribe specific, second-line drugs. The formulary identifies drugs with these guidelines as “STEP.” See the link below.

Step Therapy Guidelines 

In addition, certain drugs on the formulary have quantity limits. The formulary flags these drugs with the letters “QLL” The QLLs are established based on FDA-approved dosing levels and nationally- established, recognized guidelines pertaining to the treatment and management of the condition being treated.

To request an override for the step therapy and/or quantity limit, please fax the correct pharmacy Prior Authorization request form to 1-855-799-2550. You can include any medical records that will support your request.