Pharmacy: Aetna preferred drug list / brand and generic drug FAQs

Preferred drugs

How can I learn more about a specific drug?

Our drug information tool is a great place to start! Just type in a drug name to find out what the drug is used for, how it should be taken and what your doctor should know about you before prescribing the drug.

You can also use our drug interactions tool to learn if your medicines may interact with other medicines or vitamins you currently take, foods that you eat, medical conditions you may have, and more.

Disclaimer: Aetna assumes no responsibility for any circumstances arising out of the use, misuse, interpretation or application of any information or other material provided on the Gold Standard site.

If unable to find the information about potential drug to drug interactions, a drug’s common side effects, or availability of generic substitutes using the online tools, call 1-800-670-3566 to speak with a pharmacist. Leave your Aetna member identification number, date of birth, phone number including area code and the name of the drug or drugs in question. A pharmacist will return your call within 24 hours.

Are my drugs safe? How can I prevent a medicine error?

We invite you to read:  A Guide to Safe and Effective Medication Use: What You Can Do to Help Prevent Medication Errors.

What is a Formulary?
It’s a list of drugs that can help you save money. We choose drugs for it that are safe and cost effective — they’re the drugs your health benefits or insurance plan prefers that you use. So when your doctor prescribes one of these drugs, it can help you control the cost of health care. Or lower the costs you pay out of pocket. The formulary includes both generic and brand-name drugs. Each drug is approved by the U.S. Food and Drug Administration (FDA). Any changes are based on the latest medical findings, as well as information from the FDA and drugmakers. You’re not limited to using formulary drugs. But you may save when you do. So talk with your doctor to see if one might be right for you. There are two ways to learn more about the formulary:

  • Aetna Preferred Drug (formulary) Guide: It gives you an overall view of the drugs your plan covers.
  • Aetna Preferred Drug (formulary) List: It lists recent changes to the guide. For example, it could show what drugs recently started to require, or no longer require, coverage reviews like precertification, step therapy or quantity limits.

To access this information, take these steps:

  1. Visit www.aetna.com/formulary.
  2. You arrive at a page that says “Medication Search.” Enter your plan type. Then scroll down a bit and enter the name of a drug that you are interested in learning more about. Then click “Continue.”
  3. You arrive at a page where you can learn more about the types of drug coverage reviews your drug requires; things like precertification, step therapy or quantity limits. On this page, you can choose to click the link on the top left side of the page that says “Other Pharmacy Benefit Information.” You will arrive at a menu page where you can view various drug lists, including the Preferred Drug Guides and more.

My drug was on the Preferred Drug (formulary) Guide last year, but now it's not. Why?
We have a committee that meets regularly to review new drugs and information about drugs that are on the market. The Preferred Drug (formulary) List shows you what drugs were recently added or removed from the Preferred Drug (formulary) Guide. Drugs can be added to or removed from the Preferred Drug Guide at any time:

  • As brand-name drugs lose patents and generic versions become available, the brand-name drug may be covered at a higher copayment while the generic may be covered at a lower copayment.
  • The FDA approves many new drugs throughout the year.
  • Drugs can be withdrawn from the market or may become available without a prescription. Over-the-counter (OTC) drugs are not generally covered under a prescription plan.

We might also move a drug from one coverage tier to another.

How can I see what drugs are on the Preferred Drug (formulary) Guide or Preferred Drug (formulary) List?

To access this information, take these steps:

  1. Visit www.aetna.com/formulary.
  2. You arrive at a page that says “Medication Search.” Enter your plan type. Then scroll down a bit and enter the name of a drug that you are interested in learning more about. Then click “Continue.”
  3. You arrive at a page where you can learn more about the types of drug coverage reviews your drug requires; things like precertification, step therapy or quantity limits. On this page, you can choose to click the link on the top left side of the page that says “Other Pharmacy Benefit Information.” You will arrive at a menu page where you can view various drug lists, including the Preferred Drug Guides and more.

Or, call Rx Member Services at the toll-free number on your member ID card.

How can I get a drug added to the Preferred Drug (formulary) Guide?
Aetna Pharmacy Management regularly reviews drugs to determine what should be on the Preferred Drug (formulary) Guide. Your doctor may write to us to request that a drug be added. Your doctor should provide copies of peer reviewed medical literature to validate the superiority of the drug requested to be added. A committee will review and consider the request.

How can I view the Preventive Medicine list? 
Here is the 2014 Preventive Medicine List  (PDF, 138 KB).

What are Preventive Medications? How does Aetna choose which drugs are considered Preventive Medications?

Preventive medications are generally prescribed for people who may be at risk for certain diseases or conditions but who are not yet showing signs. Preventive care does not include drugs or medicines for treatment of an existing illness or condition. Preventive medications are used to prevent: 

  • a disease or condition;
  • complications from a disease; or
  • reoccurrence of a condition.

We selected drug classes that are largely used for preventive purposes and are associated with several highly common conditions. People with these conditions can be symptom-free if the condition is managed well; failure to manage these conditions can result in serious illness or injury.

The Preventive list reflects guidance provided by the U.S. Department of Treasury indicating that certain drugs could be covered as preventive for selected conditions under a High Deductible Health Plan (HDHP).  The drugs were selected based on Federal guidance and according to clinical and pharmacoeconomic criteria, including: relative high-prevalence of the diseases underlying the use of the drugs, clinical indication, as well as therapy class effectiveness towards preventing an illness or a reoccurrence of an illness.

Note: The Preventive Medicine List, mentioned here, has a specific purpose. It's meant for members in High Deductible Health Plans (HDHPs). It shows which drugs they can receive a deductible waiver for, under the terms of the Preventive and Chronic Program. This list is not to be confused with the list of drugs that the Affordable Care Act, also referred to as health care reform, considers to be preventive.

How can I view the Chronic Medicine List?
Here is the 2014 Chronic Medicine List  (PDF, 142 KB).

What are Chronic Medications? How does Aetna choose which drugs are considered Chronic Medications?
Chronic medications are used to treat an ongoing condition (that has been diagnosed) regardless of the risk for complications and for which an individual may be currently experiencing symptoms.
Chronic medications are drugs used in the treatment of chronic conditions, such as:

  • Hypertension
  • Hyperlipidemia
  • Diabetes
  • Depression
  • Heart disease
  • Asthma
  • Heart failure
  • Psychotic disorders such as schizophrenia or bipolar disorder.

We selected several drug classes that are used to treat highly common chronic conditions. People with these conditions can be symptom-free if the condition is managed well; failure to manage them can result in serious illness or injury.

How can the Chronic and Preventive Medicine lists apply to me?

Some plans waive the deductible for drugs on the Chronic and Preventive Medicine Lists. If you have a deductible, check for these programs on your secure Aetna Navigator website. Look under Benefits/Summary to see if these deductible waiver programs apply to you.
View the 2014 Chronic and Preventive Medicine List  (PDF, 162 KB).

 

Brand and Generic Drugs

What are generic drugs?
Generic drugs use the same active ingredients as brand-name drugs and work the same way. So they have the same risks and benefits as brand-name drugs. However, they typically cost less.

A generic drug is the same as a brand-name drug in:

  • Dosage
  • Safety
  • Strength
  • Quality
  • The way it works
  • The way it is taken
  • The way it should be used

What is the difference between generic and brand-name drugs and how does my plan treat them differently?
Generic drugs will most often:

  • Cost less
  • Be a different color, shape or size
  • Have different fillers, binders, coloring agents and flavorings (these are called “inactive ingredients”)

The use of generics is a valuable way to reduce overall prescription drug costs without sacrificing quality. Generic drugs make economic sense for Aetna members because under most of our plans they have a lower copayment. Depending on your plan design, you get a therapeutically equivalent drug for less money.

Why are brand-name drugs more expensive?
Brand-name drugs are generally more expensive than generics because drug makers invest money to support the research, development and marketing of each new medicine. They look to recover some of these costs with higher pricing. Because there are no pricing controls, manufacturers can set their own prices on patent-protected drugs.

When a patent expires on a brand-name drug, generic manufacturers can produce a generic version. Because generic drug makers are not introducing a new drug, they avoid the expenses of developing it. This is reflected in the lower price.

How do I know that a brand-name drug and generic drug are the same?
There are many myths and misconceptions about generic drugs. Some people believe quality is tied to cost, and that a cheaper drug has a lower quality. It simply is not true.

The Food and Drug Administration (FDA) approves brand-name drugs. It approves generic drugs, too. To be approved, a generic drug must:

  • Have the same active ingredients in the same amount as the brand-name drug.
  • Be identical to the brand-name drug in dose, form and the way it's administered. For instance, if a brand-name drug is a tablet taken by mouth, the generic must also be a tablet taken by mouth.
  • Have the same uses, cautions, warnings and labeling as the brand-name drug.
  • Have absorption rates that closely match the brand-name drug. The time it takes the body to absorb the generic drug and the amount absorbed at a given time interval must be nearly the same as the brand-name drug.
  • Meet batch consistency requirements for identity, strength, purity and quality. Each batch of the generic drug must be identical in every way to all other batches of the generic and brand-name product.

If brand-name drugs and generic drugs have the same active ingredients, why do they look different?
In the United States, trademark laws don't allow generic drugs to look exactly like brand-name drugs. But they must duplicate the active ingredients.

Are generic drugs as safe as brand-name drugs?
Yes. The FDA requires that all drugs be safe and effective. Since generics use the same active ingredients and are shown to work the same way in the body, they have the same benefits and risks as their brand-name counterparts.

Are generic drugs as strong as brand-name drugs?
Yes. The FDA requires generic drugs to have the same strength as brand-name drugs.

Does every brand-name drug have a generic alternative drug?
No. Only about half of the brand-name drugs on the market today have a generic alternative. Some drugs are protected by patents and are supplied by only one company.

Are generic drugs right for me?
Generic drugs can help you get more for your health care dollars. These drugs are generally less expensive than brand-name drugs, but they do the same job. Talk to your doctor. Ask if a generic drug is available and appropriate to meet your needs.

What do I have to do at the pharmacy to get the generic version of a drug?
Most pharmacies can substitute a generic drug for a brand-name drug. In fact, many will make the switch automatically, unless your state law says they can’t.

However, your doctor may have written “DAW” on your prescription. This stands for “dispense as written.” It means that the pharmacy can’t give you a generic drug instead of a brand-name one without calling your doctor. Your doctor may do this if he or she believes that the generic drug is not right for you.

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