Pharmacy

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.

September 2017

Additions

  • MESALAMINE TAB 1.2GM
  • MOXIFLOXACIN SOL 0.5% ophthalmic drops

August 2017

Additions

  • ISENTRESS HD TAB 600MG    
  • OLOPATADINE HCL 0.2% OPTHALMIC SOLUTION
  • ERGOCAL     CAP 2500UNIT  
  • MELPHALAN   TAB 2MG
  • OLOPATADINE 0.1% Ophthalmic Solution
  • Ribasphere 200mg tablets
  • Ribasphere 200mg capsules
  • Spinosad Susp 0.9%
  • Corlanor
  • Pulmozyme
  • Kitabis, 300/5ml, Neb
  • Basaglar
  • Letairis tablet
  • Tracleer tablets, all strengths
  • Epoprostenol Sodium powder for injection

Deletions

  • Cetirizine HCl Chew Tab 5 MG
  • Cetirizine HCl Chew Tab 10 MG
  • Potassium Chloride Oral Soln 10%
  • Potassium Chloride Oral Soln 20%
  • Potassium Chloride Packet 20 mEq
  • Potassium Chloride Packet 25 mEq
  • Ribavirin Cap 200 MG
  • Ribavirin Tab 200 MG
  • Ribavirin Tab 400 MG
  • Ribavirin Tab 600 MG
  • Ribavirin Pack
  • Chlorpromazine HCl Tab 10 MG
  • Chlorpromazine HCl Tab 25 MG
  • Chlorpromazine HCl Tab 50 MG
  • Chlorpromazine HCl Tab 100 MG
  • Chlorpromazine HCl Tab 200 MG
  • Fluphenazine HCl Tab 1 MG
  • Fluphenazine HCl Tab 2.5 MG
  • Fluphenazine HCl Tab 5 MG
  • Fluphenazine HCl Tab 10 MG
  • Benzyl Alcohol Lotion 5% (Ulefsia)
  • Econazole Nitrate Cream 1%
  • Acyclovir Ointment 5%
  • Azelastine HCl Nasal Spray 0.15%
  • Doxycycline Hyclate   DR tablets
  • Doxycycline Mono 75mg Capsules
  • E.E.S 400mg
  • ERY-TAB TAB - all strengths
  • ERYTHROCIN TAB 250MG
  • ERYTHROMYCIN BASE TABLETS
  • Erythromycin w/ Delayed Release Cap
  • Fluoxetine 10mg tablet
  • Niacin ER tablet
  • Nitroglycerin Solution (Pump/Spray)
  • Tetracycline capsules, all strengths
  • Metronidazole 1% gel
  • Lantus Vials
  • Insulin Glargine Pens
  • Levemir 100 U/ml vial
  • Levemir 100 U/ml Flextouch Pen
  • Alcohol pad/swabs- only certain NDCs not all

July 2017

Additions

  • Atomoxetine (all strengths)

Deletions

  • Strattera (all strengths)
  • Somatropin for Subcutane
  • Somatropin for inj 10 mg

JUNE 2017

No Changes

MAY 2017

Additions

  • Hydroxyprogesterone: Generic 17-HP
  • Methylphenidate LA 60mg  : Generic Ritalin LA 60mg
  • OTC Differin
  • OTC Calcium Acetate

APRIL 2017

Additions

  • Ivermectin, Pin-X and Reeses (pyrantel pamoate)-
  • Selzentry 25mg and 75mg tablets-
  • Linzess 72 mcg capsule-
  • Levalbuterol Tartrate Inhal Aerosol –with ST

MARCH 2017

Additions

  • GUANFACINE   TAB 1MG-QLL
  • GUANFACINE   TAB 1MG-QLL
  • DEXTROAMPHETAMINE TAB 5MG-QLL
  • DEXTROAMPHETAMINE TAB 10MG-QLL
  • DEXTROAMPHETAMINE CAP 5MG ER-QLL
  • DEXTROAMPHETAMINE CAP 10MG ER-QLL
  • DEXTROAMPHETAMINE CAP 15MG ER-QLL
  • METHYLPHENIDATE TAB 10MG ER-QLL
  • METHYLPHENIDATE TAB 20MG ER-QLL
  • METHYLPHENIDATE CAP 20MG ER-QLL
  • METHYLPHENIDATE CAP 30MG ER-QLL
  • METHYLPHENIDATE CAP 40MG ER-QLL
  • TRIUMEQ-PA
  • LOPINIVIR/RITONIVIR SOLUTION-PA
  • EZITIMIBE-ST
  • EPINEPHRINE

Changes

  • AMPHETAMINE/DEXTROAMPHETAMINE TAB 5MG-QLL
  • AMPHETAMINE/DEXTROAMPHETAMINE TAB 7.5MG-QLL
  • AMPHETAMINE/DEXTROAMPHETAMINE TAB 10MG-QLL
  • AMPHETAMINE/DEXTROAMPHETAMINE TAB 12.5MG-QLL
  • AMPHETAMINE/DEXTROAMPHETAMINE TAB 15MG-QLL
  • AMPHETAMINE/DEXTROAMPHETAMINE TAB 20MG-QLL
  • AMPHETAMINE/DEXTROAMPHETAMINE TAB 30MG-QLL
  • AMPHETAMINE/DEXTROAMPHETAMINE CAP 5MG ER-QLL
  • AMPHETAMINE/DEXTROAMPHETAMINE CAP 10MG ER-QLL
  • AMPHETAMINE/DEXTROAMPHETAMINE CAP 15MG ER-QLL
  • AMPHETAMINE/DEXTROAMPHETAMINE CAP 20MG ER-QLL
  • AMPHETAMINE/DEXTROAMPHETAMINE CAP 25MG ER-QLL
  • AMPHETAMINE/DEXTROAMPHETAMINE CAP 30MG ER-QLL
  • GUANFACINE   TAB 1MG ER-QLL
  • GUANFACINE   TAB 2MG ER-QLL
  • GUANFACINE   TAB 3MG ER-QLL
  • GUANFACINE   TAB 4MG ER-QLL
  • STRATTERA 10MG-QLL
  • STRATTERA 18MG-QLL
  • STRATTERA 25MG-QLL
  • STRATTERA 40MG-QLL
  • STRATTERA 60MG-QLL
  • STRATTERA 80MG-QLL
  • STRATTERA 100MG-QLL
  • DEXMETHYLPHENIDATE TAB 2.5MG-QLL
  • DEXMETHYLPHENIDATE TAB 5MG-QLL
  • DEXMETHYLPHENIDATE TAB 10MG-QLL
  • METHYLPHENIDATE CAP 10MG-QLL
  • METHYLPHENIDATE CAP 20MG-QLL
  • METHYLPHENIDATE CAP 30MG-QLL
  • METHYLPHENIDATE CAP 40MG-QLL
  • METHYLPHENIDATE CAP 50MG-QLL
  • METHYLPHENIDATE CAP 60MG-QLL
  • METHYLPHENIDATE TAB 5MG-QLL
  • METHYLPHENIDATE TAB 10MG-QLL
  • METHYLPHENIDATE TAB 20MG-QLL
  • METHYLPHENIDATE TAB 18MG ER-QLL
  • METHYLPHENIDATE TAB 27MG ER-QLL
  • METHYLPHENIDATE TAB 36MG ER-QLL
  • METHYLPHENIDATE TAB 54MG ER-QLL
  • METHYLPHENIDATE SOL 5MG/5ML-QLL
  • METHYLPHENIDATE SOL 10MG/5ML-QLL
  • MODAFINIL TAB 100MG-QLL
  • MODAFINIL TAB 200 MG-QLL

FEBRUARY 2017

Additions

  • Savella
  • Chlorzoxazone
  • Orphenadrine
  • Imbruvica
  • Gilenya
  • Tecfidera
  • Auryxia
  • Apriso
  • Viokace
  • Zarxio
  • Olopatadine 0.1% soln
  • Mesalamine 800mg DR
  • Zepatier
  • Epogen

Deletions

  • Lidocaine 3% lotion
  • Doxycycline hyclate IR
  • Doxycycline Monohydrate 150mg Capsule
  • Minocycline tablets
  • Nystatin/Triamcinolone combination cream/ointment
  • Cipro HC
  • Ciprodex
  • Naproxen Sodium 550mg
  • Fluoxetine 20mg and 60mg Tablets
  • Venlafaxine ER tablet
  • Buspirone 30mg
  • Mupirocin cream

Weight loss products will no longer be covered

  • Diltiazem ER/LA Tablets
  • Clomipramine
  • Imipramine CAPS*
  • Trazodone 300mg tab
  • Metaxalone 400mg and 800mg*
  • Carisoprodol 250mg
  • Tizanidine
  • Clindamycin Aerosol
  • Clindamycin/Benzoyl Peroxide combo
  • Erythromycin/Benzoyl Peroxide combo*
  • Sulfacetamide/Sulfur*
  • Claravis
  • TRETINOIN EM CRE 0.05%*
  • SALICYLIC AC GEL 6% *
  • BP WASH LIQ 7%*
  • BPO CREAMY KIT 4% WASH*
  • BPO GEL 4*
  • Copaxone 20mg*
  • Farxiga*
  • Renvela/Renagel*
  • Delzicol
  • Dipentum
  • Pentasa
  • Amitiza
  • Pancreaze
  • Advair *
  • Symbicort*
  • Spiriva
  • Tudorza*

JANUARY 2017

Additions

  • Stribild
  • Truvada
  • Isentress

Changes

Prior Authorizations to provide a diagnosis will NOW be required for all FIRST fill HIV medications.

DECEMBER 2016

Additions

  • NILUTAMIDE TAB 150MG
  • NITROGLYCERN SUB 0.3MG
  • NITROGLYCERN SUB 0.4MG
  • NITROGLYCERI SUB 0.6MG
  • ERYTHROM ETH SUS 200/5ML
  • Deletions
  • NILANDRON TAB 150MG
  • NITROSTAT SUB 0.3MG
  • NITROSTAT SUB 0.4MG
  • NITROSTAT SUB 0.6MG
  • E.E.S. GRAN SUS 200/5ML
  • ERYPED SUS 200/5ML

October 2016

Additions

  • Carbamazepine ER tablets, OLL
  • Rosuvastatin calcium- PA, QLL
  • Entresto- PA, QLL
  • Anoro Elipta-     QLL,
  • Stiolto- ST, QLL
  • Linzess- Step QLL
  • Movantik- PA; QLL
  • Rabeprazole- QLL 
  • Omeprazole QLL
  • Lansoprazole QLL 
  • Genvoya- QLL
  • Tivicay- QLL
  • Descovy- QLL
  • Cabometyx- PA; QLL
  • Ciprofloxacin Otic-
  • Prevacid Solu-tabs –PA,GF current utilizers
  • Pantoprazol-remove st  will GF current utilizers

Deletions

  • Crestor

July 2016

Additions

  • Testosterone Cyprinate for injection with PA
  • Testosterone ethinate for injection with PA
  • Zepatier with PA
  • Carbamazepine ER tablets , 100mg with age limits of 6 years and older
  • Humalog Pens with age limit to process for School age children
  • Novolog Pens with age limit to process for School age children
  • Minocycline IR capsules
  • Paricalcitrol with Step Therapy via Calcitriol
  • Rozerem with Step Therapy via zolipem and zaleplon
  • Azopt with Step Therapy via dorzolamide
  • Acyclovir  Ointment with ADD Step Therapy  via acyclovir oral
  • Lantus Pens
  • Levemir  Pens
  • Methotrexate 25mg/ml
  • Suprax 200mg chewable tablets
  • Cefixime 100mg/5ml and 200mg/5ml suspension
  • Abreva
  • Naratriptan
  • Lamotrigine IR
  • Lamotrigine ER
  • Calcipotriene Cream

Deletions

  • Januvia with NO Grandfathering
  • Janumet with NO Grandfathering
  • Janumet XR with NO Grandfathering
  • Patanol with Grandfathering
  • generic Patanol ( olopatadine) with Grandfathering
  • Byetta with NO Grandfathering
  • Harvoni
  • Sovaldi
  • Sensipar with Grandfathering current utilizers
  • Temazepam, 7.5mg and 22.5mg with Grandfathering current utilizers
  • Minocycline ER tablets with Grandfathering current utilizers
  • Paroxetine ER with Grandfathering current utilizers
  • Nevanac with Grandfathering current utilizers
  • Azasan with Grandfathering current utilizers
  • Lumigam  0.01% ophthalmic with Grandfathering current utilizers
  • Bimaroprost 0.03% ophthalmic with Grandfathering current utilizers
  • Calcipotriene Oint with Grandfathering current utilizers

Changes

  • Adding Step Therapy to Azelastine with Grandfathering current utilizers
  • Adding Step Therapy through Metformin to Tanzeum
  • Adding Age Limits to Tramadol ( not to process without a PA < 16 y/o with no Gf)
  • Adding Quantity Limits for Gabapentin 800mg  except  for certain disease states
  • Increasing Quantity Limits on Chambers and Spacers to 2/per year
  • Adding Quantity Limits to Nexavar
  • Adding Quantity Limits to Viread

 

May 2016

Additions

  • Naratriptan with QLL
  • Abreva OTC ointment
  • IV Pamidronate
  • IV Ibandronate
  • Tanzeum with Step TX
  • Thalidomide with PA
  • Revlimid with PA
  • Sutent with PA and QLL
  • Votrient with PA and QLL
  • Tykerb with PA and QLL
  • Entecavir with QLL
  • Lamivudine HBV (100mg tablets and solution) with QLL
  • Testosterone ethinate for injection with PA
  • Testosterone topical* (Androgel and Testim) with PA
  • Capecitabine with PA and QLL
  • imatinib  tablets with PA and QLL

April 2016

Additions

  • Page 43                Olopatadine (generic Patanol)

Changes

  • Page 35                Fragmin change QLL to reflect 42 syringes for 21 days
  • Page 35                Enoxaparin change QLL to reflect 42 syringes for 21 days
  • Page 35                ondaparinux change QLL to reflect 42 syringes for 21 days

Removals

  • Page 29                Norditropin
  • Page 29                Norditropin Nordiflex
  • Page 29                Armour Thyroid with GF
  • Page  37               Generess FE  with GF
  • Page  20               Lanoxin tablets with GF
  • Page 19                Methylin tablets with GF
  • Page 35                Nephrocaps with GF
  • Page  6                 Suprax suspension

March 2016

Additions

  • Page 6        Harvoni with PA
  • Page 6        Sovaldi with PA
  • Page 22      Candesartan
  • Page 22      Candesartan/HCTZ
  • Page 22      Irbesartan/HCTZ
  • Page 22      Losartan/HCTZ
  • Page 22      Valsartan/HCTZ
  • Page 12      Imatinib tablets (generic Gleevec)

Removals

  • Page 12      Brand Gleevec

February 2016

Additions

  • Page 44 adding Flovent Diskus

January 2016 (effective 1/4/16)

Additions

  • Page 32. Glatiramer Acetate (Glatropa) – Adding with PA
  • Page 28. Tradjenta- Adding with ST
  • Page 28. Jentadueto- Adding with ST
  • Page 32. Aubagio- Adding with PA
  • Page 28. Invokana- Adding with ST
  • Page 28. Invokamet- Adding with ST
  • Page 28. Farxiga-Adding with ST
  • Page 28. Trulicity-Adding with ST
  • Page 29. Omnitrope Vials –Adding with PA
  • Page 48. Hyalgan-Adding with PA
  • Page 48. Modafanil –Adding with PA with QL #30/30
  • Page 48. Gel-One-Adding with PA
  • Page 46. Tolterodine IR (Detrol IR)- Adding with ST
  • Fondaparainux (Arixtra)- Adding with PA (21 day supply available without authorization)
  • Octreotide (Sandostatin)- Adding with PA
  • Tasgina-Adding with PA
  • Page 25. Topical Tacrolimus-Adding with ST
  • Page 35. Amicar
  • Rectiv
  • Page 43. Epinastine-Adding with ST

PA/Step Therapy Changes (effective 1/4/16)

  • Page 44 Budesonide Respules (Pulmicort Respules)-Adding Age edit Page 30. Pantoprazole (Protonix) – Adding Step Therapy
  • Page 44 EpiPen , EpiPen Jr.- Adding Step Therapy

Deletions (effective 1/4/16)

  • Page 29 Nutropin
  • Page   7 Macrodantin 25mg
  • Page 35 Aminocaproic Acid
  • Page 30 RX Lansoprazole
  • Page 30 RX Omeprazole
  • Page 32 Avonex
  • Page 32 Betaseron

October 2015

  • P. 44    Remove Adrenaclick
  • P. 44    Add Epinephrine 0.3mg/0.3ml and 0.15mg/0.15ml pens
  • P. 11    Add Prior Authorization to Daraprim

September 2015

  • P. 45      Add Incruse to Formulary
  • P. 44      Add Arcapta to Formulary
  • P.44       Add Striverdi Respimat to Formulary
  • P.24       Add Crestor to Formulary
  • P.45       Add Adrenclick generic to Formulary
  • P.30       Add  OTC Esomeprazole (generic OTC Nexium) to Formulary with QLL of 60/30 days
  • P.30       Add OTC Lansoprazole ( generic OTC Prevacid) to Formulary with QLL of 60/30 days
  • P.12       Add Bexarotene Tablets (generic Targretin) to Formulary
  • P.12       Remove Targretin Tablets from Formulary
  • P.13       Add PA to Morphine Sulfate ER- adding smart edit to bypass PA process for diagnosis of Cancer and Sickle Cell
  • P.13       Add PA to Oxymorphone ER
  • P.13       Add PA  to  Fentanyl Patches- adding smart edit to bypass PA process for diagnosis of Cancer and Sickle Cell
  • P.13       Add STEP to Oxycontin with smart edit to bypass Pa process for diagnosis for Cancer and Sickle Cell

August 2015

  • P.19: Add PA for all members <6 y/o and > 18Y/o
    • amphetamine/dextroamphetamine (Adderall,Adderall XR)
    • dextroamphetamine
    • dexmethylphenidate (Focalin)
    • guanfacine ER tablets (Intuniv)
    • METHYLIN CHEWABLE
    • methylphenidate, er tabs, solution (Ritalin, Methylin)
    • methylphenidate er, sr (Ritalin LA, SR)
    • methylphenidate er 18 mg, 27 mg, 36mg, & 54mg)
    • methylphenidate hcl (Ritalin)
    • methylphenidate CD (METADATE CD)
    • STRATTERA 
  • P.9 : Atovaquone (Mepron) removed PA and changed to STEP requiring generic Bactrim with in the last 130 days unless contraindicated
  • P.12: Added PA to Nexavar
  • P.11: Added PA to Gleevec
  • P.12: Added PA to Tarceva 
  • P.35: Added  to Formulary without a PA for first 45 days of therapy                                     
    • Eliquis
    • Pradaxa
    • Xarelto

July 2105

  • P.12: Remove Teslac Tablets
  • P.15: Remove Mephobarbital
  • P.45: Remove OTC Sudagest cold and allergy tablets
  • P.45: Remove OTC q tap cold and allergy elixir
  • P.42: Remove Dipiverfrin HCL
  • P.39: Remove Natalcare glosstabs
  • P.32: Remove Viokase 8,16
  • P.41: Remove Femhrt
  • P.41 Add norethindrone/ethinyl estradiol (generic Femhrt)

June 2015

  • P.13: Add Terbinafine to formulary with QL 84 tablets /year

May 2015

  • P. 6 : Add QL Lidocaine Patches of 3 patches /day
  • P.13: Add Oxymorphone ER to formulary with STEP and QL 60 tablets /30 days
  • P.13: Add Oxymophone  IR   to formulary with STEP
  • P.17: Add QL of Ondansetron 4mg and 8mg tablets  to 21 tablets/ 30 days
  • P.17: Add QL of Ondansetron Solution to 50ml/30 days
  • P.46: Add QL of Glucose Test Strips to 150 strips/ 30 days

 April 2015

  • P. 44:  Add Spiriva Respimat to formulary with STEP and QL 1 box/30 days
  • P. 22:  Remove STEP for valsartan and valsartan HCT
  • P. 22:  Add amlodipine/valsartan (generic Exforge) to formulary with QL 30/30 days
  • P. 22: Add amlodipine/valsartan/HCTZ (generic Exforge HCT) to formulary with QL 30/30 days

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.

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.