Prescription Drugs

What is the D-SNP Plan Formulary?

The Aetna® D-SNP plan formulary is a list of drugs selected in consultation with a team of health care providers. The drugs we chose represent the prescription therapies believed to be a necessary part of a quality treatment program. Aetna will generally cover the drugs listed on our formulary as long as the drug is medically necessary.

View the latest Formulary. The formulary is continuously under review, and as changes occur, the version on the website is updated.

For a drug that is not on the List of Covered Drugs (formulary), a statement must be provided documenting trial and failure of the formulary medications or a medical reason why the formulary medications cannot be used.

For information on benefits, see Part D Prescription Drug. For more information on prescription drug coverage, please view the Evidence of Coverage and other materials, or contact Member Services at 1-855-463-0933 (TTY: 711) 8 AM to 8 PM, seven days a week.

 

Find preferred drugs

We’ve compiled the Part B Step Therapy Preferred Drug Lists below for your convenience. Please click below:

2022 Part B Step Therapy Preferred Drug list (PDF)

 

Abraxane® Abraxane (albumin-bound paclitaxel) Medicare (PDF)
Actemra® Actemra (Tocilizumab) Medicare (PDF)
AvsolaTM Avsola (infliximab-axxq) Injectable Medicare (PDF)
Beovu® Beovu (brolucizumab-dbll) Injectable Medicare (PDF)
Botox / Xeomin Botulinum Toxins Medicare (PDF)
Entyvio® Entyvio (Vedolizumab) Medicare (PDF)
Epogen/Procrit Erythropoiesis Stimulating Agents (ESAs) Medications/Dialysis Medicare (PDF)
Evenity® Evenity (Romosozumab) Medicare (PDF)
Eylea® Eylea (Aflibercept) Medicare (PDF)
Fulphila® Pegfilgrastim (Fulphila, Neulasta, Nyvepria, Udenyca, and Ziextenzo) Medicare (PDF)
Granix® Filgrastim (Granix, Neupogen, Nivestym, Zarxio) Medicare (PDF)
Herceptin® Herceptin (trastuzumab) Medicare (PDF)
Ilumya™ Ilumya (Tildrakizumab) Medicare (PDF)
Parenteral Immunoglobulins Immune Globulin (IG) Therapy Medicare (PDF)
Inflectra® Inflectra (Infliximab) Medicare (PDF)
Lemtrada® Lemtrada (Alemtuzumab) Medicare (PDF)
Lucentis® Lucentis (Ranibizumab) Medicare (PDF)
Neulasta® Pegfilgrastim (Fulphila, Neulasta, Nyvepria, Udenyca, and Ziextenzo) Medicare (PDF)
Neupogen® Filgrastim (Granix, Neupogen, Nivestym, Zarxio) Medicare (PDF)
Nivestym™ Filgrastim (Granix, Neupogen, Nivestym, Zarxio) Medicare (PDF)
Nyvepria® Pegfilgrastim (Fulphila, Neulasta, Nyvepria, Udenyca, and Ziextenzo) Medicare (PDF)
Orencia® Orencia (Abatacept) Medicare (PDF)
Prolia®/Xgeva® Prolia, Xgeva (Denosumab) Medicare (PDF)
Remicade® Remicade (Infliximab) Medicare (PDF)
Remodulin Pulmonary Arterial Hypertension (Infusible, Inhalation, or Injectable Medication) Medicare (PDF)
Renflexis® Renflexis (Infliximab-abda) Medicare (PDF)
Rituxan® Rituxan (Rituximab) Medicare (PDF)
Simponi Aria® Simponi Aria Medicare (PDF)
Stelara® Stelara (Ustekinumab) Medicare (PDF)
Tysabri® Tysabri (Natalizumab) Medicare (PDF)
UdenycaTM Pegfilgrastim (Fulphila, Neulasta, Nyvepria, Udenyca, and Ziextenzo) Medicare (PDF)
Viscosupplementation Viscosupplementation Medications Medicare (PDF)
Zarxio® Filgrastim (Granix, Neupogen, Nivestym, Zarxio) Medicare (PDF)
Ziextenzo® Pegfilgrastim (Fulphila, Neulasta, Nyvepria, Udenyca, and Ziextenzo) Medicare (PDF)