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Preferred Drug List for the Aetna Medicare Rx^SM Plans

Are your prescription drugs covered by the Aetna Medicare Rx^SM Plans? Check the Aetna Medicare Preferred Drug List, also known as our formulary, which includes brand-name and generic drugs. Pharmacists and physicians from both within and outside the company help develop the list. Select one of the links below to look for your covered medications in Aetna Medicare's formulary. We update this information regularly.

• Use the Aetna Medicare Solution Center to find your medication and compare plan costs.
  
  

  - Select the plan year in the Compare Plans section,
  - Choose “Formulary Finder” on the left under Helpful Tools,
  - Enter your zip code,
  - Select the plan you're interested in, and
  - Enter your prescription drug information.

• View and/or print the 2008 Aetna Medicare Rx plan comprehensive formulary (drug list)  (132 pages)
  
  
• Find recent changes to our formulary on Aetna Medicare's Drug List Changes page
  
  
• Have questions or can't find a specific prescription drug? Call us for information at 1-800-529-5586 (TTY/TDD 1-800-628-3323), Monday - Friday, 8 a.m. - 6 p.m.

All drugs are FDA approved

All the medications on the preferred drug list (or formulary) have been approved by the U.S. Food and Drug Administration (FDA). This includes generic drugs as well as brand-name drugs. When a doctor prescribes medications from the preferred drug list, 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. Not all approved drugs are on Aetna's preferred drug list. To decide whether an FDA-approved medication belongs on Aetna's preferred drug list, Aetna evaluates its safety, effectiveness and value in comparison with similar drugs.

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 Member Assistance section under Member Documents and Forms. Find your plan, open the PDF, and go to the "Drug Management Programs" section.

What is the preferred drug list?

Aetna Medicare prescription drug plans cover both brand-name and generic drugs.

• Brand-name 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 drugs usually cost less than brand-name drugs and are considered by the FDA to be as safe and effective as brand-name drugs.

Regular updates keep the preferred drug list current

The Aetna Medicare Preferred Drug List 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 Preferred Drug List to make sure it meets the criteria for safety, effectiveness and overall value. Medications may be covered at a higher copayment and/or removed from the Preferred Drug List with advance notice of the change.
  
  
• 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 Preferred Drug List 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 Preferred Drug List to be unsafe, or if the drug's manufacturer removes the drug from the market, we will immediately remove it from the Aetna Medicare Preferred Drug List.

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 Preferred Drug List.
  
  
• You can ask us to change coverage restrictions or limits on your medication.
  
  
• If you are in an open formulary plan, such as the Aetna Medicare Rx Plus or Aetna Medicare Rx Premier plan, 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. Most decisions will be made within 72 hours of your request.

Public notice of transition process

All Medicare prescription drug plans include a transition provision for medications that are not on our Aetna Medicare Preferred Drug List or are included in our precertification or step-therapy programs. To lessen the impact that changing coverage can have upon you, 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 preferred drug list, 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 cost-shares for the transition supply will be as if the drug was on our preferred drug list.

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 prescriptions to a drug on our preferred drug list 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.

Contact Us
Questions? Call us at 1-800-529-5586, (TTY/TDD 1-800-628-3323)
Monday - Friday, 8 a.m. - 6 p.m.
 Find general Medicare contact information.

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Updated 10/2007