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.
PA’s Prescription Drug Monitoring Program
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Register with PA’s Prescription Drug Monitoring Program
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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.
Prior authorization for drugs
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Prior authorization request forms A - L
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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.
Anticoagulant Injectable Agents
Atypical Antipsychotics Long-Acting Injectables
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Prior authorization request forms M - Z
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To quickly find a prior authorization form, click "CTRL F" on your keyboard and type in the form name.
Second generation TKIs for CML
Somatostatin analogs and Somavert
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Prior authorization guidelines
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To quickly find a prior authorization guideline, click "CTRL F" on your keyboard and type in the guideline name.
Atypical Antipsychotics long-lasting injections
Erythropoiesis Stimulating Agent
Growth Hormone and related agents
Injectable Osteoporosis Agents
Interferons (non-Hepatitis C uses)
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Non-formulary guidelines A - L
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To quickly find a non-formulary guideline, click "CTRL F" on your keyboard and type in the guideline name.
Biologic Response Modifiers (Orencia, Xeljanz, Cosentyx, Entyvio, Tysabri, Stelara)
Hyperlipidemia Agents (PCSK9 Inhibitors, Crestor, Juxtapid, Kynamro)
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Non-formulary guidelines M - Z
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To quickly find a non-formulary guideline, click "CTRL F" on your keyboard and type in the guideline name.
Non-Calcium based phosphate binders
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Specialty medications
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Specialty medications are for a variety of conditions, such as cancer, hemophilia, immune deficiency, multiple sclerosis and rheumatoid arthritis. They can be filled at any network pharmacy, but not all pharmacies may carry these medications. All specialty medications require prior authorization. If filled at a specialty pharmacy specialty medications can often be delivered to the provider’s office, member’s home or other location as requested.
Providers can call 1-866-638-1232 to request prior authorization, or complete the applicable prior authorization form and fax to 1-877-309-8077.
Specialty medications can be delivered to the provider’s office, member’s home or other location as requested.
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Over-the-counter product list
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Medicaid and tobacco cessation
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Incontinence supplies
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Pharmacy and therapeutics committee minutes
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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.