First Page of PDF Disclaimers:
14.03.942.1 (1/07)
*Also available through a participating retail pharmacy or through Aetna Specialty Pharmacy. For more information on Aetna Specialty Pharmacy, visit www.AetnaSpecialtyPharmacy.com or call 1-866-782-2779 (ASRX) or
TDD: 1-877-833-2779 (ASRX).
PR = Drug requires precertification only if the pharmacy plan includes the precertification drug program. Precertification will be processed by Medical Patient Management.

Second Page of PDF Disclaimers:
14.03.942.1 (1/07) ©2007 Aetna Inc.
PR = Drug requires precertification only if the pharmacy plan includes the precertification drug program.
Precertification will be processed by Medical Patient Management.
Aetna is the brand name used for products and services provided by one or more of the
Aetna group of subsidiary companies. The Aetna companies that offer, underwrite or
administer benefits coverage include Aetna Health Inc., Aetna Health of California Inc.,
Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance
Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance
Company.
With the exception of Aetna Rx Home Delivery® service, all participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. Aetna Rx Home Delivery, LLC., is a subsidiary of Aetna Inc. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. Notice of the change shall be provided in accordance with applicable state law.
This material is for informational purposes only. While this material is believed to be accurate as of the print date, it is subject to change. Health benefits and health insurance plans contain limitations and exclusions.