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Your pharmacy benefits
At Aetna Better Health® of Texas, we cover a variety of prescription and over-the-counter (OTC) medicines to keep you healthy. We’ll even mail your medicine so you can save time and effort.
Medications your plan covers
Medications your plan covers
Prescription medications
We cover medications on the preferred drug list (PDL) for STAR (Medicaid) members at no extra cost. Members of the Children’s Health Insurance Program (CHIP) may have to pay a small copay (usually $3 or less).
For coverage, medications need to be medically necessary. This means you need them to manage your health. The PDL also has generic versions of brand-name drugs. If your medication isn’t on the list, ask your provider to:
- Prescribe a similar one that’s on the PDL
- Get prior authorization (PA) for coverage
Need prior authorization (PA)? Just ask your provider to fill out a pharmacy PA form. Or they can contact us.
The preferred glucose meter and test strips are Lifescan OneTouch® products. The preferred lancets and lancing devices are Lifescan OneTouch Delica® and Delica® Plus. Non-preferred diabetic supplies require prior authorization (PA).
Still not sure if we cover your medication? Just contact us. When you call, have a list of your prescription medications ready. We can check them for you.
Understand your medication
If you take medication, be sure to tell your provider about all the medications you take. You’ll want to understand what your medication is for and how to take it. This includes:
- Nonprescription medicines
- Vitamins
- Herbal supplements
Check out these medication tips to learn more.
Hepatitis C treatment coverage update schedule English (PDF) | Spanish (PDF)
OTC medications on the PDL
You can get coverage for OTC medications on the PDL when you:
- Meet any added requirements (for some medications)
- Get a prescription from your provider
- Fill your OTC prescription at a pharmacy in our network
Still not sure if we cover your medication? Just contact us. When you call, have a list of your OTC medications ready. We can check them for you.
$25 for OTC products
You can get $25 per month toward some OTC medications and supplies. And we’ll mail them directly to you. Just have your member ID number ready when you place your order:
Online: Just sign in with your member ID and password. Or create a new account if you’re a first-time visitor.
By phone: You can call 1-888-628-2770 (TTY: 1-877-672-2688) Monday through Friday, 9 AM to 8 PM.
Get medications and refills
Get medications and refills
If you need medication, your provider or dentist will write you a prescription for one on the PDL. You’ll want to:
- Ask your provider to make sure the medication is on the PDL
- Take your prescription to a pharmacy in our network
- Show your plan member ID card at the pharmacy
Need refills? Your medication label notes how many refills you have. Well before you run out of medication, call your pharmacy to place a refill order. If the pharmacy doesn’t have any refills left and you need more medication, check with your provider or dentist at least five days before you run out of medication. They may want to see you before prescribing refills.
Fill your prescriptions
In person
You can fill your prescriptions at any pharmacy in our network. We can’t cover medications that you fill at other pharmacies.
Get started with mail service
You can sign up for mail service:
Online
Log in to the Member Portal. Go to “Tasks” and then “Pharmacy Services.” Go to Caremark.com by clicking on the “CVS” link. Then, choose “start mail service” to print the mail-order form.
By phone
Just call CVS Caremark® at 1-855-271-6603 (TTY: 1-800-231-4403) You can call 24 hours a day, 7 days a week. If you say it’s okay, they’ll call your provider to get a prescription.
Specialty medications
Specialty medications
If your provider prescribes a specialty medication, you can fill it at any pharmacy in our network. Not all pharmacies carry these medications. So you may need to find a specialty pharmacy. Some conditions that need specialty medications include:
- Cancer
- Hemophilia
- Immune deficiency
- Multiple sclerosis
- Rheumatoid arthritis
Your provider will need to get PA for these medications. They can contact us to ask for PA.
Hepatitis C notice — English (PDF) | Spanish (PDF)
Emergency medication supply
During an emergency, your pharmacy can provide you with a 72-hour supply of prescribed medication when:
- The medication is non-preferred on the PDL or the medication needs PA
- The prescriber isn’t able to complete the PA
- You need the medicine right away
This process is only for emergencies, not routine use.
Learn more about emergency medication supplies
Help with non-covered medications
The Vendor Drug Program may not cover all medically necessary medicines and supplies. In these cases, the Comprehensive Care Program (CCP) may be able to help. This is for members from birth through age 20. To find a CCP pharmacy provider, you can contact Texas Medicaid and Healthcare Partnership (TMHP). Just call 1-800-335-8957.
Medication recalls
Need info about medication recalls? Just call the U.S. Food and Drug Administration (FDA) at 1-888-463-6332. Or visit the drug recalls page on the FDA website.
Pharmacy access and rules
The PDL is up to date with covered medicines. Remember that some medications need PA before you can get them.
What is the Pharmacy Lock-in program?
This program aims to find potential abuse or misuse of medical or pharmacy benefits. We ask those in the program to choose one in-network pharmacy to fill prescriptions and stick with it. Or we can choose one for them.
Why are certain members in the program?
Our goal is safety. We want to help members get the best care possible.
What happens if a member’s chosen pharmacy doesn’t have the medicine they need?
Members will be able to get a 72-hour supply of medicine from a different pharmacy. They can also do this in an emergency.
What if members don’t want to use only one pharmacy?
Members can file an appeal. To get started, they can contact us. They have 60 days to file an appeal from the date on the letter about the Lock-in program.