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.

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.

Universal Pharmacy Prior Authorization Forms

Buprenorphine Universal PA Form

Universal General Pharmacy PA Form

 

To search press "CTRL + F" and type in the name you are looking for

 

Acamprosate

Actemra

Acromegaly Agents

Actimmune

ADD-ADHD Non-Stimulants

Afinitor

Alphanate-Humate

Ampyra

Anticoagulants-Injectable

Anticoagulants-Oral

Antidepressants Non-Formulary

Aranesp

Atypical Antipsychotics-Long Acting Injection

Bosulif

Botulinum Toxins

Brand Name Drugs

Buprenorphine Universal

Cabometyx

Cambria

Caprelsa

Celecoxib (Celebrex)

Chantix

Cialis for BPH

Cimzia

CNS Stimulants

Colony Stimulating Factors

Cometriq

Cosentyx

Crestor

Daliresp

Deraprim

DPP-4 Inhibitors

Duavee

Dysport Myobloc Xeomin

Egrifta

Eligard [Brand Only] Trelstar Vantas

Enbrel

Entresto

Entyvio

Epogen-Procrit 

Erivedge

Factor IX Agents

Factor VIII Agents

Forteo

Gleevec

GLP-1 Agonists

Growth Hormones

Hepatitis C

Humira

Hyaluronic Acid Derivatives

Iclusig

ICP Entyvio

ICP Epogen Procrit

ICP Hetlioz

ICP Increlex

IL-5 Antagonists

Ilaris

Inlyta

Insulin Pens

Intravaginal Progesterone Products

Intron A Alferon N

Jakafi

Juxtapid-Kynamro

Kalydeco

Kineret

Leukine

Leuprolide Acetate

Lidocaine Patch

Lupron Depot-Lupaneta

Lyrica

View the latest formulary updates

Aetna Better Health Specialty Drug Program is managed through CVS Health Specialty Pharmacy. The Specialty pharmacies fill prescriptions and ship drugs for complex medical conditions, including hepatitis C, multiple sclerosis, hemophilia, rheumatoid arthritis and most cancer drugs. Medications provided through CVS specialty pharmacy include injectable, oral and inhaled drugs.

The Specialty Drug Program provides care management services to your members, including:

  • 24 hours a day, seven days a week access to a pharmacist
  • Disease-specific education and counseling by the CareTeamTM. The CareTeamTM are clinical professionals who review dosing and medication schedules, identify injection issues, provide education of potential side effects and provide information to help your patient to manage their medical condition.
  • Care coordination
  • Delivery of Specialty drugs to your patient’s home and/or your office in temperature-controlled packaging with the required supplies, i.e. needles, syringes, and alcohol wipes or patients can be directed to drop off and pick up most of their prescriptions at any CVS Pharmacy location (including those inside Target stores*)

Contact CVS Specialty Pharmacy at 1-800-237-2767 from 7:30 a.m. (EST) to 9:00 p.m. (EST) time, Monday – Friday. CVS Specialty Pharmacy will assist you in filling your patient’s specialty drug. Prior Authorization (PA) still applies to specific specialty drugs. You can check our health plan website to confirm PA requirements on the medications listed below.

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

Additional Pharmacies in the specialty network:

Walmart Pharmacies (Specialty Only): Phone: 1-877-453-4566 Fax: 1-866-537-0877

WellPartner Pharmacy: Phone: 1-800-473-3516 Fax: 1-877-597-3070

University of Kentucky Specialty Pharmacy: Phone: 1-844-730-5913 Fax: 1-859-218-5413

Duncan Prescription Center: fax: 1-270-247-6033

BioRx: fax: 1-513-792-3838

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.