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

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

ADD/ADHD Non-Stimulants                        

ADD/ADHD Stimulants                                 

Anticoagulants Oral                                        

Antihyperlipidemics                                        

Antipsychotic                                                  

Anti-TNF’s                                                      

Atypical Antipsychotics long-lasting injections        

Botulinum Toxins                                            

Buprenophine                                                  

Colony Stimulating Factors                             

Compound Guideline                                      

Diabetic testing supplies                                  

Erythropoiesis Stimulating Agent                   

Growth Hormone and related agents              

Hemophilia                                                      

Hepatitis C                                                      

Injectable Anticoagulants                                

Injectable Osteoporosis Agents                       

Interferons (non-Hepatitis C uses)                  

Lyrica                                                              

Modafinil and Nuvigil

MS Agents

Multaq

Multiple Sclerosis

Narcotic

Oncology - Antineoplastic Agents

PAH

Proton Pump Inhibitors (PPI)

Quantity Limits

Revlimid

Somatostatin Analogs

Step Therapy

Sutent

Synagis

Testosterone

Thalomid

Xolair

To quickly find a non-formulary guideline, click "CTRL F" on your keyboard and type in the guideline name.

Affinitor                                                          

Ampyra                                                           

Antidepressants Nonformulary                       

ARBs                                                              

Biologic Response Modifiers (Orencia, Xeljanz, Cosentyx, Entyvio, Tysabri, Stelara)        

Bosulif                                                             

Botulinum Toxins                                            

Cambia                                                            

Capecitabine                                                    

Caprelsa                                                           

Cialis                                                               

Cometriq                                                         

CSF                                                                 

Cystic Fibrosis Agents                                    

Daliresp                                                           

Daraprim                                                         

Direct Renin Inhibitors                                   

Duavee                                                            

Egrifta                                                             

ESA                                                                 

GnRH Inhibitors                                             

Hemophilia Factors                                         

Hetlioz                                                             

Hyaluronic                                                       

Hyperlipidemia Agents (PCSK9 Inhibitors, Crestor, Juxtapid, Kynamro)   

Iclusig                                                              

Imatinib                                                           

Inlyta

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.