Pharmacy

The pharmacies in our network are changing

You’ll have to pay the full cost of your medicine if you use a pharmacy that isn’t in our network as of July 1,2020.

To make sure that your covered prescriptions are paid for by Aetna Better Health of New Jersey, always fill your prescriptions at a network pharmacy. These are the pharmacies included in your plan. Your network pharmacies include:


Any CVS Pharmacy® (including those inside Target® stores)
Most local neighborhood pharmacies
Many hospital pharmacies

This change may not affect you right now. Just remember it’s best to always get your medicine at a network pharmacy. If you are filling prescriptions at a pharmacy that will no longer be in the network, you will soon get a letter about how to:


Find a new pharmacy
Transfer (move) your current prescriptions to this pharmacy

As a member of Aetna Better Health of New Jersey you do not have to pay for covered prescriptions if you fill at a network pharmacy.

You can visit aetnebetterhealth.com/nj or contact member services at 1-855-232-3596 (TTY: 711) for a list of network pharmacies

 

As a member of Aetna Better Health of New Jersey you do not have to pay for covered prescriptions if you fill at a network pharmacy.

 

Call the  U.S. Food and Drug Administration toll-free at 1‑888‑INFO-FDA (1‑888-463-6332) or visit www.fda.gov to learn more about recent drug recalls.

If you need medicine, your provider will choose a drug from our list of preferred drugs.

  • Your provider will write you a prescription. Ask your provider to make sure that the medicine is on our list.
  • Take the prescription to a network pharmacy to have it filled.
  • Show your Aetna Better Health of New Jersey member ID card at the pharmacy.

You can find a network pharmacy in your area or you can call Member Services toll-free at 1-855-232-3596, TTY 711. Ask for help in finding a find a network pharmacy in your area.

You must fill your prescription at a network pharmacy. Your prescriptions won’t be covered at other pharmacies.

You can look to see if your medicines are on the preferred drug list or formulary. Listed drugs are usually covered under the plan. They need to be medically necessary. The formulary also lists the generic substitutes. The formulary can change. You can also use the searchable formulary.

If you’re not sure your medicines are covered, you can call Member Services toll-free at 1-855-232-3596, TTY 711. Have a list of your prescriptions ready when you call. Ask the representative to look up your medicines to see if they are on the list.

November 2020

Additions:

  • Emtricitabine Cap 200mg (Prior Authorization Required, Quantity Level Limit)

 Removals:

  • Emtriva Cap

 

October 2020

Additions:

  • Dimethyl Fumarate Delayed Release Caps 120mg, 240mg (Prior Authorization Required, Quantity Level Limit)
  • Efavirenz-Lamivudine-Tenofovir DF Tabs 400-300-300mg, 600-300-300mg (Prior Authorization Required, Quantity Level Limit)
  • Emtricitabine-Tenofovir Disoproxil Fumarate Tab 200-300mg (Prior Authorization Required, Quantity Level Limit)
  • Vancomycin HCL IV Sol’n 750mg/150ml, 1250mg/250ml, 1750mg/350ml

 Removals:

  • Prenatrix Tab
  • Psyldex Powder 30%
  • SB Fiber Laxative Powder 33%
  • SB Natural Fiber Laxative Power 49%
  • Symfi Lo Tab 400-300-300mg
  • Symfi Tab 600-300-300mg
  • Tecfidera Caps Delayed Release 120mg, 240mg
  • Vitrexyl Tabs
  • Truvada Tab 200-300mg

 

 September 2020

Additions:

  • Abiraterone Tab 250mg (Prior Authorization Required)
  • Alecensa Cap 150mg (Prior Authorization Required)
  • Austedo Tabs 6mg, 9mg, 12mg (Prior Authorization Required)
  • Bexarotene Cap 75mg (Prior Authorization Required)
  • Budesonide Cap 3mg (Step Therapy Required, Quantity Level Limit)
  • Caprelsa Tabs 100mg, 300mg (Prior Authorization Required)
  • Cinacalcet Tabs 30mg, 60mg, 90mg (Prior Authorization Required)
  • Cyclophosphamide Caps 25mg, 50mg
  • Enbrel Inj 25mg/0.5ml (Prior Authorization Required, Quantity Level Limit)
  • Erivedge Cap 150mg (Prior Authorization Required)
  • Gilotrif Tabs 20mg, 30mg, 40mg (Prior Authorization Required)
  • Jakafi Tabs 5mg, 10mg, 15mg, 20mg, 25mg (Prior Authorization Required)
  • Kalydeco Pak 25mg, 50mg, 75mg (Prior Authorization Required)
  • Kalydeco Tab 150mg (Prior Authorization Required)
  • Lenvima Caps Therapy Pack 4mg, 8mg, 10mg, 12mg, 14mg, 18mg, 20mg, 24mg (Prior Authorization Required)
  • Linezolid Tab 600mg (Prior Authorization Required)
  • Mekinist Tabs 0.5mg, 2mg (Prior Authorization Required)
  • Ofev Caps 100mg, 150mg (Prior Authorization Required)
  • Omeprazole DR Tab 20mg (OTC) (Quantity Level Limit)
  • Repatha Inj 140mg/ml (Prior Authorization Required)
  • Repatha Push Inj 420/3.5ml (Prior Authorization Required)
  • Repatha Sure Inj 140mg/ml (Prior Authorization Required)
  • Rydapt Cap 25mg (Prior Authorization Required)
  • Soliris Inj 10mg/ml (Prior Authorization Required)
  • Symdeko Tabs 50-75mg, 100-150mg (Prior Authorization Required)
  • Tafinlar Caps 50mg, 75mg (Prior Authorization Required)
  • Venclexta Tab Starter Pak (Prior Authorization Required)
  • Venclexta Tabs 10mg, 50mg, 100mg (Prior Authorization Required)
  • Xolair Inj 75/0.5ml, 100mg/ml (Prior Authorization Required)
  • Xolair Sol 150mg (Prior Authorization Required)

Removals:

  • Travoprost (BAK Free) 0.004% Ophthalmic Sol

Other Updates:

  • Aripiprazole Tabs 2mg, 5mg, 10mg, 15mg, 20mg, 30mg (Age Limit)
  • Clozapine Tabs 25mg, 50mg, 100mg, 200mg (Age Limit)
  • Olanzapine ODT Tabs 5mg, 10mg, 15mg, 20mg (Age Limit)
  • Olanzapine Tabs 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg (Age Limit)
  • Proton Pump Inhibitors (Quantity Level Limit)
  • Quetiapine Tabs 25mg, 50mg, 100mg, 200mg, 300mg, 400mg (Age Limit)
  • Risperidone ODT Tabs 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg (Age Limit)
  • Risperidone Solution 1mg/ml (Age Limit)
  • Risperidone Tabs 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg (Age Limit)
  • Ziprasidone Caps 20mg, 40mg, 60mg, 80mg (Age Limit)

 

August 2020

Additions:

  • Amitiza Caps 8mcg, 24mcg (Prior Authorization Required, Age Limit, Quantity Level Limit)
  • Athletes Foot (Miconazole Nitrate) Powder 2% (Quantity Level Limit)
  • Diclofenac Solution 1.5% (Step Therapy Required, Quantity Level Limit)
  • Ibrance Caps 75mg, 100mg, 125mg (Prior Authorization Required, Quantity Level Limit)
  • Ibrance Tabs 75mg, 100mg, 125mg (Prior Authorization Required, Quantity Level Limit)
  • Lynparza Tabs 10mg, 15mg (Prior Authorization Required, Quantity Level Limit)
  • Miconazole Nitrate Aerosol Powder 2% (Quantity Level Limit)
  • Poly-Vi-Sol Solution 50mg/ml
  • Ropinirole ER Tabs 2mg, 4mg, 6mg, 8mg, 12mg (Step Therapy Required)
  • Solifenacin Succinate Tabs 5mg, 10mg (Step Therapy Required, Quantity Level Limit)
  • Symproic Tab 0.2mg (Prior Authorization Required, Quantity Level Limit)
  • Testosterone Gel 1.62% (Prior Authorization Required, Quantity Level Limit)
  • Testosterone Gel Pump 1% (Prior Authorization Required)
  • Testosterone TD Solution 30mg/Actuation (Prior Authorization Required, Quantity Level Limit)
  • Tivicay PD Tab 5mg (Prior Authorization Required, Age Limit)
  • Trelegy Ellipta Inhaler 100-62.5-25mcg (Step Therapy Required, Quantity Level Limit)
  • Tri-Vi-Sol Solution A/C/D

Removals:

  • Cimduo Tab 300-300mg
  • Fluocinolone Acetonide Solution 0.01%
  • Fluorouracil Cream 0.5%
  • Humulin 70/30
  • Humulin N
  • Humulin R
  • Kitabis Solution 300mg/5ml
  • Naproxen Sodium Tab 275mg
  • Nimodipine Cap 30mg
  • Targretin Gel 1%
  • Tolmetin Cap 400mg
  • Tolmetin Tabs 200mg, 600mg

Other Updates:

  • Acetic Acid/Hydrocortisone OTIC Solution (Quantity Level Limit)
  • Adapalene Gel 0.1% RX (Removed Step Therapy)
  • Auryxia Tab 210mg (Step Therapy Required)
  • Betamethasone Dipropionate Aug Cream 0.05% (Quantity Level Limit)
  • Betamethasone Dipropionate Cream 0.05% (Quantity Level Limit)
  • Betamethasone Dipropionate Lotion 0.05% (Quantity Level Limit)
  • Betamethasone Valerate Cream 0.1% (Quantity Level Limit)
  • Betamethasone Valerate Lotion 0.1% (Quantity Level Limit)
  • Betamethasone Valerate Ointment 0.1% (Quantity Level Limit)
  • Butenafine HCl Cream 1% (Quantity Level Limit)
  • Candesartan Cilexetil – Hydrochlorothiazide Tabs 16-12.5mg, 32-12.5mg, 32-25mg (Step Therapy Required)
  • Candesartan Cilexetil Tabs 4mg, 8mg, 16mg, 32mg (Step Therapy Required)
  • Ciclopirox Olamine Cream 0.77% (Quantity Level Limit)
  • Ciclopirox Olamine Suspension 0.77% (Quantity Level Limit)
  • Ciclopirox Shampoo 1% (Quantity Level Limit)
  • Ciclopirox Solution 8% (Quantity Level Limit)
  • Ciprofloxacin OTIC Solution 0.2% (Quantity Level Limit)
  • Clindamycin Gel 1% (Quantity Level Limit)
  • Clindamycin Lotion 1% (Quantity Level Limit)
  • Clindamycin Pads 1% (Quantity Level Limit)
  • Clindamycin Solution 1% (Quantity Level Limit)
  • Clotrimazole Cream 1% (Quantity Level Limit)
  • Clotrimazole Solution 1% (Quantity Level Limit)
  • Clotrimazole-Betamethasone Cream 1-0.05% (Quantity Level Limit)
  • Disulfiram Tabs 250mg, 500mg (Quantity Level Limit)
  • Ear Drops (Carbamide Peroxide) OTIC Solution 6.5% (Quantity Level Limit)
  • Erythromycin Gel 2% (Quantity Level Limit)
  • Erythromycin Solution 2% (Quantity Level Limit)
  • Fluocinonide Cream 0.05% (Quantity Level Limit)
  • Fluocinonide Solution 0.05% (Quantity Level Limit)
  • Fluvastatin Caps 20mg, 40mg (Step Therapy Required)
  • Hydrocortisone Cream 0.5%, 1%, 2.5% (Quantity Level Limit)
  • Hydrocortisone Lotion 1%, 2.5% (Quantity Level Limit)
  • Hydrocortisone Ointment 0.5%, 1%, 2.5% (Quantity Level Limit)
  • Ketoconazole Cream 2% (Quantity Level Limit)
  • Ketoconazole Shampoo 2% (Quantity Level Limit)
  • Lidocaine Ointment 5% (Quantity Level Limit)
  • Linzess Caps 72mcg, 145mcg, 290mcg (Prior Authorization Required)
  • Liothyronine Tab 25mcg (Quantity Level Limit)
  • Miconazole Nitrate Cream 2% (Quantity Level Limit)
  • Mometasone Furoate Cream 0.1% (Quantity Level Limit)
  • Mometasone Furoate Ointment 0.1% (Quantity Level Limit)
  • Mometasone Furoate Solution 0.1% (Quantity Level Limit)
  • Naltrexone Tab 50mg (Quantity Level Limit)
  • Neomycin-Polymixin-HC OTIC Solution 1% (Quantity Level Limit)
  • Neomycin-Polymixin-HC OTIC Suspension 3.5mg/ml-10000 Unit/ml (Quantity Level Limit)
  • Nystatin Cream 100000 Units/gm (Quantity Level Limit)
  • Nystatin Ointment 100000 Units/gm (Quantity Level Limit)
  • Nystatin Topical Powder 100000 Units/gm (Quantity Level Limit)
  • Ofloxacin OTIC Solution 0.3% (Quantity Level Limit)
  • Permethrin Cream 5% (Quantity Level Limit)
  • Permethrin Lotion 1% (Quantity Level Limit)
  • Prednicarbate Ointment 0.1% (Quantity Level Limit)
  • Scalp Relief Max Strength (Hydrocortisone) Solution 1% (Quantity Level Limit)
  • Stop Lice Maximum Strength (Pyrethrins-Piperonyl Butoxide) Liquid 0.33-4% (Quantity Level Limit)
  • Sulfacetamide Lotion 10% (Quantity Level Limit)
  • Terbinafine Cream 1% (Quantity Level Limit)
  • Tolnaftate Cream 1% (Quantity Level Limit)
  • Triamcinolone Acetonide Cream 0.025%, 0.1%, 0.5% (Quantity Level Limit)
  • Triamcinolone Acetonide Lotion 0.025%, 0.1% (Quantity Level Limit)
  • Triamcinolone Acetonide Ointment 0.025%, 0.5% (Quantity Level Limit)

 

July 2020

Additions:

  • Gvoke PFS Injection 0.5mg/0.1ml (Quantity Level Limit)

Other Updates:

  • Glucagon Emergency Kit 1mg (Quantity Level Limit)
  • Matulane Cap 50mg (Prior Authorization Required)

 

June 2020

Additions:

  • Acne Medication Lotion (Benzoyl Peroxide) 10%
  • Alahist-D Tab 17.5-10mg
  • Atovaquone-Proguanil Tabs 62.5-25mg, 250mg-100mg (Quantity Level Limit)
  • Benzoyl Peroxide Gel 2.5%
  • Claravis Caps 10mg, 20mg, 30mg, 40mg (Step Therapy, Quantity Level Limit)
  • Dovato Tab 50-300mg (Quantity Level Limit)
  • Gvoke Hypopen Inj (Quantity Level Limit)
  • Isotretinoin Caps 10mg, 20mg, 30mg, 40mg (Step Therapy, Quantity Level Limit)
  • Jock Itch/Athlete’s Foot Spray (Tolnaftate) Aerosol Powder 1% (Quantity Level Limit)
  • Primaquine Tab 26.3mg (Quantity Level Limit)

Other Updates:

  • Clotrimazole Solution 1% (Removed Step Therapy)

 

May 2020

Additions:

  • Dexamethasone Concentrate 1mg/ml
  • Dexamethasone Vials 20mg/5ml, 120mg/30ml, 10mg/ml
  • Solu-Cortef PF Vial 100mg, 250mg, 500mg, 1000mg
  • Pyrimethamine Tab 25mg (Generic) (Prior Authorization Required)

Removals:

  • Daraprim Tab (Brand)

 

April 2020

Additions:

  • Aripiprazole Tab 2mg, 5mg, 10mg, 15mg, 20mg, 30mg (Generic) (Age Limit, Quantity Level Limit)
  • Omeprazole Tab Delayed Release Disintegrating 20 Mg (OTC) (Quantity Level Limit) 
  • Orkambi Packet 100-125mg, 200-125mg (Prior Authorization Required)
  • Orkambi Tab 100-125mg, 200-125mg (Prior Authorization Required)
  • Tramadol Hcl Tab 100mg (Quantity Level Limit)

Removals:

  • Diphenhydramine Hcl Liquid 6.25mg/ml
  • Polyethylene Glycol 3350 Oral Packet
  • Psyllium Powder Packet 100%
  • Sennosides Tab 17.2mg
  • Sodium Bicarbonate Powder

Other Updates:

  • Chloroquine Tabs 250mg, 500mg (Prior Authorization Required, Quantity Level Limit)
  • Hydroxychloroquine Tab 200mg (Prior Authorization Required, Quantity Level Limit)
  • Kaletra Tabs (Quantity Level Limit)
  • Lopinavir-Ritonavir Solution 400-100mg/5ml (Quantity Level Limit) 

 

March 2020

Additions:

  • Budesonide-Formoterol Inhaler 80-4.5mcg, 160-4.5mcg (Quantity Level Limit)
  • Mesalamine Caps ER 0.375mg (Generic)
  • Nicotine Polacrilex Gum 2mg, 4mg (Age Limit)
  • Novolin R FlexPen 100 units/ml (Age Limit)  
  • OneTouch Verio Flex Kit (Quantity Level Limit)
  • Penicillamine Tab 250mg (Prior Authorization Required, Quantity Level Limit)      

Removals:

  • Ambi 60pse/400gfn Tab
  • Apriso Caps ER 0.375gm (Brand)
  • Artificial Tears Solution 1% Ophthalmic
  • Diflunisal Powder
  • Fluoritab Solution 0.275 (0.125 F) Mg/Drop
  • Hydrocodone-Acetaminophen Solution 10-325 Mg/15ml
  • PR Natal 430 Pak
  • PR Natal 400, 430 Pak Ec
  • Prevident Solution Rinse
  • Regenecare Ha Gel 2%
  • Robitussin Syrup 7.5 Mg/5ml
  • Sodium Chloride Solution 0.9% Injection

 

February 2020

Additions:

  • Bimatoprost Solution 0.03% (Step Therapy)
  • Ethinyl Estradiol – Etonogestrel Ring 0.015/0.12mg (Quantity Level Limit)
  • Travoprost Ophthalmic Solution

Removals:

  • Alprazolam Concentrate 1mg/ml Solution
  • Chlorothiazide Tabs 250mg, 500mg
  • Demeclocycline Tabs 150mg, 300mg
  • Doxycycline Monohydrate Tab 150mg
  • First-Vanco Solution 25mg/ml, 50mg/ml
  • Methyclothiazide Tabs 5mg
  • Mirena
  • Nausea Liquid Relief (fructose-dextrose-phosphoric acid)
  • Nizatidine Solution 15mg/ml
  • Nuvaring (Brand)
  • Rabeprazole EC Caps 20mg
  • Ranitidine Caps 150mg, 300mg
  • Skyla
  • Travatan Z Ophthalmic Solution (Brand)

Other Updates:

  • Atropine Sulfate Ophthalmic Ointment 1% (Quantity Level Limit)
  • Atropine Sulfate Ophthalmic Solution 1% (Quantity Level Limit)
  • Buspirone Tabs 5mg, 7.5mg, 10mg 15mg (Age Limit)
  • Combigan Solution 0.2%/0.5% (Quantity Level Limit)
  • Diazepam Concentrate Solution 5mg/ml (Quantity Level Limit)
  • Diazepam Oral Solution (Quantity Level Limit)
  • Diazepam Tabs 2mg, 5mg, 10mg (Quantity Level Limit)
  • Divalproex Er Tabs 250mg, 500mg (Prior Authorization Required)
  • Dorzolamide Hcl-Timolol Maleate Ophthalmic Solution 22.3-6.8mg/ml (Step Therapy, Quantity Level Limit)
  • Doxycycline Monohydrate Suspension 25mg/ml (Age Limit)
  • Granisetron Tab 1mg (Step Therapy)
  • Hydroxyzine Hcl Syrup 10mg/5ml (Quantity Level Limit)
  • Hydroxyzine Hcl Tab 50mg (Quantity Level Limit)
  • Hydroxyzine Pamoate Caps 25mg, 50mg, 100mg (Quantity Level Limit)
  • Ibrandronate Inj 3mg/3ml (Quantity Level Limit)
  • Levofloxacin Solution 0.5% (Quantity Level Limit)
  • Lorazepam Conc 2mg/ml (Age Limit, Quantity Level Limit)
  • Memantine Hcl Tabs 5mg, 10mg (Quantity Level Limit)
  • Methazolamide Tabs 25mg, 50mg (Step Therapy)
  • Tazarotene Cream 0.1% (Step Therapy)
  • Timolol Gel Ophthalmic Solution 0.25%, 0.5% (Quantity Level Limit)
  • Trifluridine Ophthalmic Solution 1% (Quantity Level Limit)

 

January 2020

Removals:

  • Ventolin HFA Inhaler (Brand)

 

December 2019

Additions:

  • Bunavail Buccal Film 2.1-0.3mg, 4.2-0.7mg, 6.3-1mg (Brand) (Step Therapy Required, Quantity Level Limit)
  • Buprenorphine-Naloxone Film 2-0.5mg, 4-1mg, 8-2mg, 12-3mg (Generic) (Step Therapy Required, Quantity Level Limit)
  • Suboxone Film 2-0.5mg, 4-1mg, 8-2mg, 12-3mg (Brand) (Step Therapy Required, Quantity Level Limit)
  • Zubsolv Sublingual Tablets 0.7-0.18mg, 1.4-0.36mg, 2.9-0.71mg, 5.7-1.4mg, 8.6-2.1mg, 11.4-2.9mg (Brand) (Step Therapy Required, Quantity Level Limit)

Removals:

  • PreNata Chewable Tab 29-1mg

 

November 2019

Additions:

  • Aminocaproic Acid 0.25gm/ml Solution

Removals:

  • Amicar 0.25gm/ml Solution (Brand)

 

October 2019

Removals:

  • Nicadan Tab
  • Strovite Forte Tab 

 

September 2019

Additions:

  • Alinia Sus 100/5ml
  • Alinia Tabs 500mg
  • Ambrisentan Tabs 5mg, 10mg (Prior Authorization Required, Quantity Level Limit)
  • Bosentan Tabs 62.5mg, 125mg (Prior Authorization Required, Quantity Level Limit)
  • Estradiol Bi-Weekly patches 0.025mg, 0.0375mg, 0.05mg, 0.075mg, 0.1mg (Quantity Level Limit)
  • Febuxostat Tabs 40mg, 80mg (Step Therapy Required)
  • First-Omperazole Sus 2mg/Ml
  • Ramelteon Tab 8mg (Step Therapy Required, Quantity Level Limit)
  • Ribavirin Caps 200mg (Step Therapy Required)
  • Ribavirin Tabs 200mg (Step Therapy Required)
  • Sodium Chloride Neb 3%
  • Sucraid Sol 8500/Ml

Removals:

  • Letairis Tabs 5mg, 10mg (Brand)
  • Rozerem Tab 8mg (Brand)
  • Tracleer Tabs 62.5mg, 125mg (Brand)
  • Uloric Tabs 40mg, 80mg (Brand)

 

August 2019

Additions:

  • Butenafine Hcl Cream 1%
  • Emtricitabine-rilpivirine-tenofovir af tab 200-25-25 mg (Prior Authorization Required, Quantity Level Limit)
  • Lidocaine patch 4% (Quantity Level Limit)
  • Pegfilgrastim-jmdb soln prefilled syringe 6 mg/0.6ml (Prior Authorization Required, Quantity Level Limit)

Removals:

  • Butalbital-acetaminophen-caffeine cap 50-325-40 mg
  • Ciclopirox Gel 0.77%
  • Clotrimazole with Betamethasone Lotion 1-0.05%
  • Colestipol hcl granule packets 5 gm
  • Colestipol hcl granules 5 gm
  • Entecavir oral soln 0.05 mg/ml
  • Epinastine hcl ophth soln 0.05%
  • Erythromycin ethylsuccinate for susp 200 mg/5ml, 400 mg/5ml
  • Esterified estrogens tab 0.3mg, 0.625mg, 1.25mg, 2.5mg
  • Estradiol tab 1 mg(15)/estrad-norgestimate tab 1-0.09mg(15)
  • Etodolac tab er 24hr 400 mg,500 mg, 600 mg
  • Fluphenazine hcl elixir 2.5 mg/5ml
  • Fluphenazine hcl inj 2.5 mg/ml
  • Lindane shampoo 1%
  • Moexipril hcl tab 7.5mg, 15mg
  • Olopatadine HCl Ophth Solution 0.2%
  • Quinidine gluconate tab cr 324 mg

Other Updates:

  • Calcipotriene cream 0.005% (Added Prior Authorization, Changed Quantity Level Limit)
  • Calcipotriene soln 0.005% (50 mcg/ml) (Added Prior Authorization, Changed Quantity Level Limit)
  • Darunavir ethanolate tab 75mg, 150mg, 600mg, 800mg (BASE EQUIV) (Added Prior Authorization, Quantity Level Limit)
  • Delavirdine mesylate tab 200mg (Added Prior Authorization, Quantity Level Limit)
  • Didanosine delayed release capsule 125 mg (Changed Quantity Level Limit)
  • Elvitegrav-cobic-emtricitab-tenofovdf tab 150-150-200-300 mg (Added Prior Authorization Required, Changed Quantity Level Limit)
  • Etravirine tab 25mg, 100mg, 200mg (Added Prior Authorization, Quantity Level Limit)
  • Fosamprenavir calcium susp 50 mg/ml (BASE EQUIV) (Added Prior Authorization, Quantity Level Limit)
  • Fosamprenavir calcium tab 700 mg (BASE EQUIV) (Added Prior Authorization, Quantity Level Limit)
  • Indinavir sulfate cap 200mg, 400mg (Added Prior Authorization, Quantity Level Limit)
  • Lamivudine oral soln 10 mg/ml (Changed Quantity Level Limit)
  • Lidocaine cream 4% (Changed Quantity Level Limit)
  • Lopinavir-ritonavir soln 400-100 mg/5ml (80-20 mg/ml) (Added Prior Authorization, Quantity Level Limit)
  • Lopinavir-ritonavir tab 100-25 mg, 200-50 mg (Added Prior Authorization, Quantity Level Limit)
  • Nelfinavir mesylate tab 250mg, 625mg (added prior authorization, quantity level limit)
  • Nevirapine tab er 24hr 100 mg (changed quantity level limit)
  • Olanzapine orally disintegrating tab 5mg, 10mg, 15mg, 20mg (age limit)
  • Olanzapine tab 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg (age limit)
  • Quetiapine fumarate tab 25mg, 50mg, 100mg, 200mg, 300mg, 400mg (age limit)
  • Risperidone orally disintegrating tab 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg (age limit)
  • Risperidone soln 1 mg/ml (age limit)
  • Risperidone tab 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg (age limit)
  • Sertraline hcl oral concentrate for solution 20 mg/ml (Age Limit)
  • Tenofovir disoproxil fumarate oral powder 40 mg/gm (Added Prior Authorization Required, Changed Quantity Level Limit)
  • Thyroid tab 180mg (3 grain), 240mg (4 grain), 300mg (5 grain) (Changed Quantity Level Limit)

 

July 2019

Additions:

  • Erlotinib Tab 150mg (Prior Authorization Required)
  • Kevzara Injection 150mg, 200mg (Prior Authorization Required, Quantity Level Limit)
  • Mesalamine DR Cap 400mg (Quantity Level Limit)

Removals:

  • Tarceva Tab 150mg (brand)

 

June 2019

Additions:

  • Docosanol Cream 10% (Quantity Level Limit)
  • Melatonin Tabs 1mg, 3mg, 5mg

Removals:

  • Abreva Cream 10% (brand)

 

May 2019

Additions:

  • Erythromycin Ethylsuccinate Suspension 400mg/5ml
  • Nivestym Injection 300mcg, 480mcg (Prior Authorization Required)
  • Sirolimus Solution 1mg/ml

Removals:

  • Eryped Suspension (brand) 400mg/5ml
  • Rapamune Solution (brand) 1mg/ml

 

April 2019

Additions:

  • Sublocade Injection
  • Vivitrol Injection (Quantity Level Limit)

Removals:

  • Suboxone Films

Other Updates:

  • Buprenorphine Tabs (Removed Prior Authorization Required, Changed Quantity Level Limit)
  • Buprenorphine-Naloxone Tabs (Removed Prior Authorization Required, Changed Quantity Level Limit)

 

March 2019

Additions:

  • Admelog Vial 300 units/3ml
  • Albuterol HFA Inhaler 90mcg –Generic Ventolin HFA (Quantity Level Limit)
  • Mesalamine Suppository 1000mg
  • Toremifene Tab 60mg

Removals:

  • Canasa Suppository 1000mg
  • Fareston Tab 60mg
  • Norethindrone Acet-Ethinyl Estradiol-FE Tab 1mg-20mcg

Other Updates:

  • Butalbital Containing Products (Quantity Level Limit)
  • Smoking Cessation Products (Quantity Level Limit)

 

February 2019

Additions:

  • Arnuity Ellipta Inhaler
  • Calcipotriene Ointment 0.005% (Quantity Level Limit)
  • Flebogamma IV Solution 5gm/50ml, 10gm/100ml, 20gm/200ml (Prior Authorization Required)
  • Immune Globulin IV Solution 1gm/10ml, 2.5gm/25ml, 5gm/50ml, 10gm/100ml, 20gm/200ml, 30gm/300ml, 40gm/400ml (Prior Authorization Required)
  • Leuprolide Acetate Kit 1mg/0.2ml (Prior Authorization Required)
  • Ozempic Injection (Step Therapy, Quantity Level Limit)
  • Prenatal Vitamin with Ferrous Fumarate-Folic Acid Tab 27-0.8mg (Quantity Level Limit)
  • Prenatal Vitamin with ferrous Fumarate-Folic Acid Tab 28-0.8mg (Quantity Level Limit)
  • Prenatal Vitamin with Minerals-Ferrous Fumarate-Folic Acid-DHA Pack 28-0.8-200mg (Quantity Level Limit)
  • Prenatal Vitamin without Vit A with Ferrous Fumarate-Folic Acid Chewable Tab 29-1mg (Quantity Level Limit)
  • Prenatal Vitamin without Vit A with Ferrous Fumarate-Iron Polysaccharide Complex-Folic Acid Cap 20-20-1.25mg (Quantity Level Limit)
  • Segluromet Tabs (Step Therapy, Quantity Level Limit)
  • Steglatro Tabs (Step Therapy, Quantity Level Limit)
  • Victoza Injection (Step Therapy, Quantity Level Limit)

Removals:

  • Alprazolam Orally Disintegrating Tabs
  • Calcitriol Ointment
  • Cleocin Vaginal Ovule 100mg
  • Clorazepate Tabs
  • Condylox Gel 0.5%
  • Cortifoam Rectal Aerosol
  • Dihydroergotamine Products
  • Dulera Inhaler
  • Elidel Cream 1%
  • Ergotamine Products
  • Ergotamine/Caffeine Products
  • Flovent Diskus Inhalers
  • Histrelin Acetate Implant Kit 50mg
  • Humalog Vials/Pens
  • Humalog Vials/Pens
  • Invokamet Tabs
  • Invokana Tabs
  • Levonorgestrel/Ethinyl Estradiol Tab 0.1-0.02mg (84) & 0.01mg (7)
  • Lidocaine-Hydrocortisone Kit 20x7gm
  • Lidocaine-Hydrocortisone Kit 3-1%
  • Lo Loestrin FE Tabs
  • Meprobamate Tabs
  • Miconazole-3 Vaginal Suppository 200mg
  • Neonatal Plus Tab
  • Nitro-Bid Packets 2%
  • Novolog Vials/Pens
  • Novolog Vials/Pens
  • Penicillamine Cap 250mg
  • Plan B Tabs (Brand Only)
  • Prenatal Vitamin with Ferrous Fumarate-L Methylfolate-Folic Acid Tab 27-0.6-0.4mg
  • Prenatal Vitamin with Ferrous-Fumarate-Folic Acid Tab 65-1mg
  • Prenatal Vitamin with Iron Carbonyl-Folic Acid Tab 50-1.25mg
  • Prenatal Vitamin with Iron Carbonyl-Iron Aspart Glyc-Folic Acid-Omega 3 Cap 27-1mg
  • Prenatal Vitamin with Iron Polysaccharide Complex-Folic Acid Chewable Tab 29-1mg
  • Prenatal Vitamin with Minerals-Ferrous Fumarate-Folic Acid-DHA Pack 65-1mg & 250mg
  • Prenatal Vitamin with Minerals-Iron Polysaccharide Complex-Folic Acid-DHA Pack 29-1 & 250mg
  • Prenatal Vitamin without Vit A with Ferrous Fumarate-DSS-Folic Acid-DHA Cap 27-1.25-300mg
  • Prenatal Vitamin without Vit A with Ferrous Fumarate-DSS-Folic Acid-DHA Cap 27-1.25-300mg
  • Prenatal Vitamin without Vit A with Ferrous Fumarate-L Methylfolate-Folic Acid-DHA Cap 27-0.6-0.4-300mg
  • Prenatal Vitamin without Vit A with Iron Carbonyl-Ferrous Gluconate-DSS-Folic Acid-DHA Pack 27-1mg & 250mg
  • Prenatal Vitamin without Vit A with Iron Carbonyl-Ferrous Gluconate-Docusate-Folic Acid Tab 27-1mg
  • Prenatal Vitamin without Vit A with Iron Carbonyl-Ferrous Gluconate-DSS-Folic Acid-DHA Pack 35-1mg & 300mg
  • Pulmicort Flexhalers
  • Qvar Inhaler
  • Relenza Diskhaler
  • Synjardy Tabs
  • Terconazole Vaginal Suppository 80mg
  • Thalomid Caps
  • Trelstar Mix Injection 3.75mg, 11.25mg, 22.5mg
  • Tricare Tab
  • Trulicity Injection

Other Updates:

  • Abilify Maintena Injections (Quantity Level Limit)
  • Acyclovir Suspension 200mg/5ml (Age Limit)
  • Alprazolam SR Tabs (Age Limit)
  • Alprazolam Tabs (Quantity Level Limit)
  • Aristada Injections (Quantity Level Limit)
  • Breo Ellipta Inhalers (Age Limit)
  • Calcipotriene Cream 0.005% (Quantity Level Limit)
  • Calcipotriene Solution 0.005% (Quantity Level Limit)
  • Carafate Suspension 1gm/10ml (Age Limit)
  • Chlordiazepoxide Caps (Quantity Level Limit)
  • Chlorpromazine Tabs (Quantity Level Limit)
  • Citalopram Solution 10mg/5ml (Age Limit)
  • Clozapine Tabs (Quantity Level Limit)
  • Codeine Containing Products (Age Limit)
  • Dicyclomine Solution 10mg/ml (Age Limit)
  • Escitalopram Solution 5mg/5ml (Age Limit)
  • Famotidine Suspension 40mg/5ml (Age Limit)
  • Flovent HFA Inhalers (Age Limit)
  • Fluphenazine Concentrate 5mg/ml (Quantity Level Limit)
  • Fluphenazine Decanoate Injection 25mg/ml (Quantity Level Limit)
  • Fluphenazine Elixir 2.5mg/5ml (Quantity Level Limit)
  • Fluphenazine Tabs (Quantity Level Limit)
  • Fluphenazine Vial 2.5mg/ml (Quantity Level Limit)
  • Haloperidol Concentrate 2mg/ml (Quantity Level Limit)
  • Haloperidol Decanoate Injections (Quantity Level Limit)
  • Haloperidol Lactate Injection 5mg/ml (Quantity Level Limit)
  • Haloperidol Tabs (Quantity Level Limit)
  • Hydrocodone Containing Products (Age Limit)
  • Hydroxyzine HCL Tabs (Quantity Level Limit)
  • Invega Sustena Injections (Quantity Level Limit)
  • Invega Trinza Injections (Quantity Level Limit)
  • Jardiance Tabs (Remove Step Therapy, Add Prior Authorization Required)
  • Lansoprazole Suspension 3mg/ml (Age Limit)
  • Lithium Carbonate Caps (Quantity Level Limit)
  • Lithium Carbonate ER Tabs 300mg, 450mg (Quantity Level Limit)
  • Lithium Carbonate Tab 300mg (Quantity Level Limit)
  • Lithium Solution 8meq/5ml (Quantity Level Limit)
  • Lorazepam Tabs (Quantity Level Limit)
  • Loxapine Caps (Quantity Level Limit)
  • Nitrofurantoin Suspension 25mg/5ml (Age Limit)
  • Nortriptyline Solution 10mg/5ml (Age Limit)
  • Olanzapine Tabs (Quantity Level Limit)
  • Omeprazole Suspension 2mg/ml (Age Limit)
  • Oseltamivir Cap 30mg (Quantity Level Limit, Age Limit)
  • Oseltamivir Caps 45mg, 75mg (Quantity Level Limit)
  • Oseltamivir Suspension 6mg/ml (Quantity Level Limit, Age Limit)
  • Oxazepam Caps (Quantity Level Limit)
  • Perphenazine Tabs (Quantity Level Limit)
  • Prednisone Solution 5mg/5ml (Age Limit)
  • Prochlorperazine Suppository 25mg (Quantity Level Limit)
  • Prochlorperazine Tabs (Quantity Level Limit)
  • Quetiapine Tabs (Quantity Level Limit)
  • Risperdal Consta Injections (Quantity Level Limit)
  • Risperidone Orally Disintegrating Tabs (Quantity Level Limit)
  • Risperidone Solution 1mg/ml (Quantity Level Limit)
  • Risperidone Tabs 3mg, 4mg (Quantity Level Limit)
  • Thioridazine Tabs (Quantity Level Limit)
  • Thiothixene Caps (Quantity Level Limit)
  • Tramadol Containing Products (Age Limit)
  • Trifluoperazine Tabs (Quantity Level Limit)
  • Ziprasidone Caps (Quantity Level Limit)

 

January 2019

No Changes

Aetna Better Health also covers certain over-the-counter drugs, if they are on our list. 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.

You can look to see if your over-the-counter medicines are on the formulary list. You can also call Member Services toll free at 1-855-232-3596, TTY 711. Have a list of your over-the-counter medicines ready when you call. Ask the representative to look up your medicines to see if they are on the list.

Dual eligible members: Over-The-Counter (OTC) Wrap Formulary for Dual Eligible Members

*Applies only to members who have Medicare and Medicaid coverage with Aetna Better Health of New Jersey.

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. These medications may not be available at local pharmacies. Specialty medications require prior authorization before they can be filled and delivered. Providers can call 1-855-232-3596 to request prior authorization, or complete the applicable prior authorization form and fax to 1-855-296-0323.

You can ask that your specialty medications be sent to the provider’s office, your home, or another location.

If you take medicine for an ongoing health condition, you can have your medicines mailed to your home. Aetna Better Health of New Jersey works with a company called CVS Caremark to provide this service. It’s available at no cost to you.

If you choose this option, your medicine comes right to your door. You can even schedule refills.

Here are some other features of home delivery:

  • Pharmacists check each order for safety.
  • You can order refills by mail, by phone or online. You can also sign up for automatic refills.
  • You can talk with pharmacists by phone anytime, 24 hours a day, 7 days a week.

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

  • Call CVS Caremark toll-free at 1-855-271-6603 Monday to Friday between 8 a.m. and 8 p.m., Eastern Time. They’ll help you sign up for home delivery. If you say it’s OK, CVS will call your provider to get your prescription. If you have trouble hearing, call CVS Caremark TTY toll free at 1-800-231-4403.
  • Go to CVS CareMark member sign in. Then log in and sign up for mail order. If you say it's OK, CVS Caremark will contact your provider to get a prescription.
  • Ask your provider to write a prescription for a 90-day supply with up to one year of refills. Then, you complete the mail-order services form and mail it to CVS Caremark along with the prescription.

Mail the form to:
CVS Caremark
PO Box 2110
Pittsburgh, PA 15230-2110

CVS Caremark Mail-Order Service Form English / Spanish

Your medicine bottle label says how many refills you can have. If your provider or dentist has not ordered refills and you think you may need a refill, you must call him or her at least five days before your medicine runs out. When you call, ask your provider or dentist about getting a refill. They may want to see you before giving you a refill.

Aetna Better Health of New Jersey wants you to be as healthy as possible. You want to know about the different medicines you take. To help you, we have included a list of questions you should always ask your provider when he or she gives you a prescription.

  • Why am I taking this medicine? What is it supposed to do for me?
  • How should the medicine be taken? When? For how many days?
  • Are there any side effects or possible allergic reactions to this medicine?
  • What should I do if I have a side effect or allergic reaction?
  • What will happen if I don't take this medicine?

Carefully read the drug information given with your medicine. It will tell you what you should and shouldn’t do while taking the medicine. If you still have questions after you get your medicine, ask to speak with the pharmacist or call your provider.