Check Our Medicare Drug List.
See if your prescription drug is covered.
Our prescription drug list (formulary) shows:
The drugs we cover The tier a drug is on Drug requirements or limits Mail order availability through Aetna Rx Home Delivery®
Generally, the lower the tier, the less you pay. Your Evidence of Coverage (EOC) tells you the drug costs for tiers.
Check drug coverage & costs.
Or, choose your location and plan to view drug-related documents.
Other drug references.
Changes to the drug list (formulary)
We update our covered drug list monthly. We may make changes based on findings from:
The Food and Drug Administration (FDA) The Centers for Medicare & Medicaid Services (CMS) Clinical standards of care.
We don’t often discontinue or reduce drug coverage during the plan year. If we remove drugs from our list or add prior authorization, quantity limits or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify you. This must be at least 60 days before the change is effective. Or it may be when you request a refill of the drug. Then you’ll get a 60-day supply of the drug.
If the FDA views a drug on our formulary as unsafe or the drug maker removes the drug from the market, we’ll remove the drug from our formulary. We’ll send you a notice if you’re taking the drug.
Prior authorization, quantity limits & step therapy.
Some covered drugs may have additional requirements or limits. These include:
You or your doctor may need approval for certain drugs before you fill your prescriptions. If you don’t get approval, we may not cover the drug. Quantity limits.
For certain drugs, we limit the amount of the drug. We may limit coverage to 30 tablets for a 30-day supply. We may also limit fills to a one-month or three-month supply. Step therapy.
In some cases, we require you to first try certain drugs to treat your condition before we cover another drug for that condition. For example, if drug A and drug B both treat your condition, we may not cover drug B unless you try drug A first. If drug A doesn’t work for you, we’ll then cover drug B.
Look in the formulary for more requirements or limits.
If you’re a member, you can request an exception if your drug has a prior authorization, quantity limit, or step therapy requirement, or if the drug isn’t covered on our formulary.
Transition rules.
You may be on drugs that aren’t on our drug list or covered with added requirements or limits.
Talk with your doctor.
Your doctor can help you decide if you should switch to a covered drug or request a drug exception. It may help to share your formulary with your doctor. In the meantime, we may cover a temporary supply of your drug in certain cases during your first 90 days.
Transition supply.
For any of your drugs not on our drug list or covered with additional requirements or limits, we’ll cover up to a 30-day supply. This temporary supply should allow you to work with your doctor to either transition to a new drug or request an exception to continue your current drug.
You must fill your prescription at a plan network pharmacy.
After your 30-day transition supply, we won’t pay for these drugs unless you get approval for a drug exception. This is even if you’re a plan member less than 90 days.
Learn more about our transition process.
Long-term care facility residents: read this.
You can refill your prescription until we’ve given you a transition supply (91-98-day supply). This may depend on drug maker packaging or if you have a prescription written for fewer days.
We’ll cover more than one refill of these drugs for the first 90 days you’re a plan member. If you need a drug that’s not on our list or if your ability to get your medicine is limited, but you’re past the first 90 days of membership, we’ll cover up to a 31-day emergency supply of that drug. If you’re discharged or move to a new long-term care facility, your doctor or pharmacy can request a one-time prescription override. This will give you up to a 30-day supply for that drug.
Participating physicians, hospitals and other health care providers are independent contractors. They’re neither agents nor employees of Aetna. The availability of any particular provider can’t be guaranteed. Provider network make-up is subject to change.
We’re here to help!
Email us or call Member Services at the number on your ID card.
Don’t have your ID card handy?
Not yet a Member?
Email us or call an Aetna representative at (TTY: 711) , Monday to Friday, 8 a.m. to 8 p.m.
We speak your language.
We have free interpreter services to answer questions you may have about our health or drug plan.
Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.
See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.
Aetna Medicare’s pharmacy network offers limited access to pharmacies with preferred cost sharing in: rural Missouri. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use.
For up-to-date information about our network pharmacies, including pharmacies with preferred cost sharing, members please call the number on your ID card.
The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.
Y0001_4006_10829 Approved 10/27/2017.
Page last updated: May 23, 2018.
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