Pharmacy

Aetna Better Health contracts with CVS Caremark to manage the pharmacy network.

For more information, please refer to the Provider Manual

Notice to Pharmacies: Mosquito Repellent Benefit - Texas now covers mosquito repellents for the prevention of the Zika virus. 

Please note:  Beginning Jan 1, 2016 the preferred Glucose meter and Test Strips will be J&J One Touch products.

Pharmacy benefits are coordinated through CVS Caremark.

Aetna Better Health covers prescription medications. Members can get their prescriptions at no cost (Medicaid) or at low copays (CHIP) when:

  •  Prescriptions are filled at a network pharmacy.
  •  Prescriptoins are on the preferred drug list (PDL) or formulary.

It is important for providers to know about all other prescriptions members are taking. Also, doctors should ask members about non-prescription medicines, vitamins or herbal supplements they may be taking.

You can find out if a medication is on the preferred drug list. Many preferred drugs are available without prior authorization (PA).

The Texas Medicaid preferred drug list is available on the Texas Vendor Drug Program or the Epocrates website. The service is free and doctors have instant access to information about the drugs covered by the Texas formulary on a Palm or Pocket PC handheld device.

The formulary drug list is a list of drugs that are generally covered under the plan as long as they are medically necessary. This list can be found on the Texas Drug Vendor Program. If you want to request a drug to be added to the formulary please contact an your Aetna Better Health of Texas Provider Representative for assistance.

Providers can access the CVS Caremark MAC Portal.

Aetna Better Health covers certain over-the-counter drugs if they are on the formulary list. Some of these drugs might include specific requirements to be covered. If these requirements are met, Aetna Better Health will cover the drug. Check the list of covered drugs on the Texas Vendor Drug Program.

All prescriptions must be filled at a network pharmacy. Prescriptions filled at other pharmacies will not be covered.

Electronic Prescribing (e-prescribing, or eRx), allows a doctor to electronically send an accurate, error-free and understandable prescription directly to a pharmacy.

Aetna Better Health and CVS Caremark allow the submission of both paper and electronic prescriptions by doctors. Doctors that prescribe medications electronically must do so in accordance with all applicable State and Federal laws.

Doctors can assist members in completing mail order forms if members need a prescription for a maintenance medication. Find answers to frequently asked questions (FAQs) about mail order services

You can also call CVS Caremark Mail Service Pharmacy at 1-855-271-6603 or fax completed mail order form(s) to 1-800-378-0323.

Mail Order Form (English) / Mail Order Form (Spanish)

To obtain a Prior Authorization for a medication, doctors can call Aetna Better Health of Texas at:

Medicaid STAR 1-800-248-7767 (Bexar), 1-800-306-8612 (Tarrant)
Medicaid STAR Kids 1-844-STRKIDS (1-844-787-5437)
CHIP or CHIP Perinate 1-866-818-0959 (Bexar), 1-800-245-5380 (Tarrant)

Choose provider option 2.  Then choose option 6 for Pharmacy prior authorization.

Or fax an authorization form designed specifically for pharmacy requests. Doctors can download the forms here and fax the request to 1-844-275-1084. Please include any supporting medical records that will assist with the review of the prior authorization request. For all requests, allow 24 hours to complete the authorization process. 

Federal and Texas laws require pharmacies to dispense a 72-hour emergency supply of a prescribed drug when the medication is needed without delay and the prescriber is not available to complete the prior authorization. This applies to non-preferred drugs on the Preferred Drug List and any drug that is affected by a clinical Prior Authorization needing prescriber’s prior approval.

The pharmacy will submit an emergency 72-hour prescription when warranted. This procedure will not be used for routine or continuous overrides.

For further details about the 72-hour emergency supply requests, please refer to the Texas Vendor Drug Program.

The Medicaid Comprehensive Care Program (CCP) can cover medically necessary drugs and supplies that are not covered by the Vendor Drug Program for members from birth through 20 years of age. Members can call TMHP at 1-800-335-8957 to locate a participating CCP pharmacy provider.

Participating pharmacies are available to provide some Durable Medical Equipment (DME) and medical supplies to Medicaid (STAR) and CHIP plan members. These participating pharmacies are covered by the state of Texas Medicaid (STAR) and CHIP Programs.

Click here for more information about DME benefits and participating pharmacies.  

Caremark Pharmacy Help Desk  1-877-874-3317 

Texas Vendor Drug Program      1-800-435-4165

CVS Caremark provides training resources for pharmacists and medical professionals from details about drug lists to clinical programs and publications.

See CVS Caremark for more information.