Did you know?
Aetna Medicare Rx plans cover most of your Part D brand-name and generic prescription drugs.
Medicare Drug Plans
Aetna Medicare Rx Plans (PDP): Find Prescriptions
How do you know which prescriptions are covered?
Check out our Preferred Drug List for the Aetna Medicare Rx® Plans (PDP).
The Aetna Medicare Preferred Drug List, also known as our formulary, includes both brand-name and generic drugs. The formulary may change during the year, so we update this information regularly. Select one of the links below to find covered medications.
- Use our Formulary Finder tool to look up your prescriptions and compare plan costs. You’ll need to supply your zip code, choose a plan and then choose your prescriptions.
Find your prescription drugs for the 2010 plan year
2010 Comprehensive Formulary (93 pages, 342 kb) — View and/or print the 2010 Aetna Medicare Rx Plan (PDP) prescription drug list. Last Updated 10/1/2009 - Notice of Changes to the Aetna Medicare 2010 Prescription Drug Formulary (19 pages, 299 kb) - Review this file for a summary of changes to our list of covered prescription drugs that will become effective on January 1, 2010. Some medications will move to different cost-sharing tiers, some will have changes to special requirements or limits on their use, and others will no longer be covered by Aetna Medicare. Last Updated 10/1/09
Utilization Management
We require you to get prior authorization (prior approval) for certain drugs. This means that your provider will need to contact us before you fill your prescription.
We require you to participate in the step therapy program if you take a Medicare Part D prescription drug for which an equally effective and less expensive drug is available.
Prescription Drug List Changes
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All drugs are FDA approved
All the medications on the formulary have been approved by the U.S. Food and Drug Administration (FDA). This includes generic drugs as well as brand-name drugs. When your doctor prescribes medications in a preferred tier level from the formulary or one that is covered in a closed formulary, it helps you reduce costs.
The FDA promotes and protects public health by making sure prescription drugs and other products are safe, effective, and reach the market in a timely way. Once medications and other products have entered the market, the FDA keeps track of them for continued safety.
Quality assurance policies
Aetna members should refer to their Evidence of Coverage to learn more about quality assurance policies and procedures, including utilization management, drug utilization review, and medication therapy management programs. Aetna's Medicare Rx Evidence of Coverage PDF files can be found in the Help and Resources/Downloadable Forms section of this website under Evidence of Coverage. Find your plan, open the PDF, and go to the "Drug Management Programs" section.
What is the formulary?
Aetna Medicare prescription drug plans cover both brand-name and generic prescription drugs.
- Brand-name prescription drugs are those that the Food and Drug Administration (FDA) approves and the manufacturer markets with a brand or trade name. When the manufacturers lose their patents, generic versions may become available.
- Generic drugs have the same active ingredients in the same amounts as brand-name drugs. Generic prescription drugs usually cost less than brand-name prescription drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
Regular updates keep the formulary current
The Aetna Medicare formulary is updated from time to time and may change during the year. We will let affected members know at least 60 days before a medication is removed from coverage, moved to a higher cost-sharing level, or if precertification, quantity limit or step-therapy restrictions have been placed on a medication.
- From time to time, Aetna reviews the Aetna Medicare formulary to make sure it meets the criteria for safety, effectiveness and overall value.
- As brand-name medications lose their patents and generic versions become available, the brand-name medication may be covered at a higher copayment.
- The Aetna Medicare formulary may also change if a medication is taken off the market or becomes available without a prescription.
- If the Food and Drug Administration judges a drug on the Aetna Medicare formulary to be unsafe, or if the drug's manufacturer removes the drug from the market, we will immediately remove it from the Aetna Medicare formulary.
Exceptions
You and your doctor can ask Aetna to make an exception to our coverage rules if your doctor thinks it is medically necessary. There are several types of exceptions that you can ask us to make. For complete information about coverage determinations, requests for exceptions, and a copy of the form that can be used for a request, please see the Medicare Rx website section, “Exceptions, Appeals & Grievances.”
- You can ask us to cover your medication even if it is not covered on our Aetna Medicare formulary.
- You can ask us to change coverage restrictions or limits on your medication.
- You can ask us to provide a more favorable level of coverage for your medication. However, you cannot be granted an exception to lower your specialty tier cost share.
- To ask for an exception to our coverage rules, you should submit a statement from your doctor supporting your request. Decisions will be made as quickly as your health requires, but no later than 72 hours of your request.
Public notice of transition process
The Centers for Medicare and Medicaid Services (CMS) implemented a transition program to allow Medicare Part D members to receive a temporary supply of medication to avoid disruption of therapy.
Aetna has established a transition benefit that provides you with up to one courtesy fill (maximum of a 31-day supply) for each prescription you may already be taking and that is not on our formulary, or that requires precertification or step therapy. The courtesy fill can be used anytime during your first 90 days in the plan. If you reside in a long-term care facility, we will extend the courtesy fill up to two additional fills as long as they occur during your first 90 days in the plan. Your plan’s copays will apply.
Some medications may still require precertification. Examples include prescription drugs that could be covered under either the Part D or the Part B Medicare benefit and a determination of how they will be covered needs to occur. In addition, if there are safety concerns with a drug, we may require precertification.
Following your courtesy fill, you will receive a letter from Aetna letting you know what you need to do prior to filling that prescription again, in order to not interrupt your drug regimen. Of course, you always have the option to switch to prescription drugs in a preferred tier level or a covered drug on our formulary in advance of filling your prescription, which will serve to reduce your drug costs and limit any future interruptions.
You may also be eligible to receive courtesy fill(s) at other times during the year, such as changes in setting of care, emergencies, etc.
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