Pharmacy

Aetna Better Health’s formulary drug list

The Formulary is a list of drugs chosen by Aetna Better Health and a team of doctors and pharmacists that are generally covered under the plan as long as they are medically necessary. Prescriptions must be filled at an Aetna Better Health network pharmacy, and other plan rules must be followed. View our latest formulary drug list.

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

You can view a list of recent 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).

Visit Pharmacy Provider Search to view all the Aetna Better Health pharmacy providers.

Prior authorization for drugs

Heroin and opioid overdose are now the leading cause of accidental death in Pennsylvania.

To help prevent prescription drug abuse and protect the health and safety of our community, Pennsylvania's Prescription Drug Monitoring Program (PA PDMP) collects information on all filled prescriptions for controlled substances. This information helps health care providers safely prescribe controlled substances and helps patients get the treatment they need.

As of January 1, 2017, all licensed prescribers who are lawfully authorized to distribute, dispense, or administer a controlled substance in the Commonwealth of Pennsylvania are required to register with the program.

Aetna Better Health encourages prescribers and dispensers to register with the PDMP today. Help patients get the treatment they need.

Prescriber Q&A

If the drug you are requesting is not listed below, use the General Prior Authorization Request Form. Also view our list of Step Therapy guidelines.

To quickly find a prior authorization form, click "CTRL F" on your keyboard and type in the form name.

A-L

M-Z
Actimmune Modafinil, Nuvigil
ADD-ADHD non-stimulants Movantik
Afinitor-Afinitor Disperz Multaq
Alphanate-Humate Multiple Sclerosis Agents
Ampyra C4391-A Narcotic Analgesics
Anticoagulant Injectable Agents Non Calcium based phosphate binders

Anticoagulants Oral (PDF)

Northera
Antidepressants Non-Formulary Novoseven RT
Antipsychotics NSAIDs Topical
Aranesp Numega
ARBs Non-Formulary Octreotide
Atypical Antipsychotics Long-Acting Injectables Omega 3 carboxylic acids
Botulinum Toxins Oncology Antineoplastic
Brand name drugs Onychomycosis tinea
Buprenorphine-Naloxone Orencia
Cabometyx Otezla
Cambia PAH Agents
Caprelsa C6495-A PCSK9 Inhibitors
Celecoxib Platelet Inhibitors
Cialis Pomalyst
CNS Stimulants Prolia
Colony Stimulating Factors Promacta
Cometriq C6496-A Proton Pump Inhibitors
Crestor Pulmozyme
Daliresp Ranexa
Daraprim Remicade
Diabetic strips and machines Restasis-Xiidra
Direct Renin Inhibitors Revlimid
DPP-4 Savella
Duavee Second generation TKIs for CML
Elidel, Tacrolimus Step Therapy Serostim
Eligard-Trelstar-Vantas SGLT2 Inhibitors
Enbrel Somatostatin analogs and Somavert
Entresto Stelara
Epogen-Procrit Stivarga
Erivedge Stutent
Esbriet – Ofef Supprelin
Factor IX Agents Symlin
Factor VIII Agents Synagis
Forteo Synarel
GLP-1 Tarceva
Growth Hormone Testosterone
Hep C Thalomid
Hetlioz Tobramycin Cayston
Humira Topical Hyaluronic Acid Derivatives
Hyaluronic Acid Topical NASIDs
IL-5 Antagonists Tysabri
Increlex Tykerb
Intravagional Progesterone Vivitrol
Intron A Xalkori
Isotretinoin Xeloda
Juxtapid – Kynamro Xolair
Kalydeco Xtandi
Leukine Zelboraf
Leuprolide Acetate Zoladex
Lidocaine Patch Zytiga
Lupron Depot
Lyrica

 

CVS Caremark Specialty Pharmacy is a pharmacy that offers medications that are not often available at local pharmacies for a variety of conditions, such as cancer, hemophilia, immune deficiency, multiple sclerosis and rheumatoid arthritis. Specialty medications require prior authorization before they can be filled and delivered.

Providers can call 1-866-638-1232 to request prior authorization, or complete the applicable prior authorization form and fax to 1-866-207-7231.

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

Aetna Better Health has a pharmacy and therapeutics (P&T) committee. Check out the committee reviewed drug recommendations:

You can also view a list of recent formulary updates.

Aetna Better Health requires prior authorization for certain drugs on the formulary drug list and for all non-formulary drug requests. You may now request prior authorization of most drugs via phone by calling the Aetna Better Health Pharmacy Prior Authorization team at 1-866-638-1232, or you may print the required prior authorization form and fax it along with supporting clinical notes to 1-877-309-8077.