• Save with Preferred Drugs
• Developing the Preferred Drug List
• Non-Preferred Drugs
• Transition from another Prescription Drug Plan
• Read Clinical Policy Bulletins
• Search the Preferred Injectable Medications List

Save with Preferred Drugs

The Preferred Drug List - also referred to as a formulary - is part of many Aetna prescription drug benefit plans. Aetna prescription drug plans generally cover the drugs listed on the Preferred Drug List as long as the drug is medically necessary and plan rules are followed. Some plans have different coverage tiers for brand-name, generic, preferred and non-preferred medications. Usually, drugs that are preferred are covered at a lower copay tier, which means you pay less out of pocket for those drugs.

Developing the Preferred Drug List

Safe and Cost-Effective Drugs
The Aetna Preferred Drug List features FDA-approved medications that are considered safe and cost-effective. It includes both brand-name and generic medications. We choose drugs for the Preferred Drug List based on reliable medical data, safety and cost. Many medications, including drugs on the Preferred Drug List, are subject to manufacturer rebate arrangements* between Aetna and the manufacturer of those medications. 

A Pharmacy and Therapeutics (P&T) Committee meets regularly to review new drugs and new information about drugs already on the market. This committee reviews available information concerning safety, effectiveness and current use in therapy. They also review the scientific evidence from DrugPoints, American Hospital Formulary Service Drug Information (AHFS-DI), DrugDex, Medline and other databases, including relevant findings of Federal government agencies, pharmaceutical manufacturers, medical professional associations, national commissions and peer-reviewed journals.

The P&T Committee includes licensed pharmacists and doctors, including those who are currently in practice and others who are Aetna employees. All committee members must tell us if they are in a situation that can create a conflict of interest or if they have a financial stake that might affect their decisions.

Once the P&T Committee completes its clinical review, we also consider overall value (including cost and manufacturer rebate arrangements) and other factors before a adding or removing a drug from the Preferred Drug List.

Changes to the Preferred Drug List
The Preferred Drug List is updated on an ongoing basis.  Drugs can be added to or removed from the Preferred Drug List at any time. We might also move a drug from one coverage tier to another.

• As brand-name medications lose their patents and generic versions become available, the brand-name medication may be covered at a higher copayment while the generic medication may be covered at a lower copayment.  
• The FDA approves many new medications throughout the year. 
• Medications 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.

Non-Preferred Drugs

Some plans do not cover non-preferred ("formulary excluded") drugs. Other plans may cover them, but at more cost to you. Also, there may be some specific drugs listed on the Preferred Drug List that your plan does not cover, such as contraceptives, infertility medications, erectile dysfunction medications and diabetic supplies.

You and your doctor are responsible for making the final decision about what medications you need to take. If you are taking a drug that is not covered or non-preferred, ask your doctor about alternative drugs. You should always follow your doctor's advice, even if a prescribed drug is not covered.

Transition from Another Prescription Drug Plan

Make a smooth transition to your new Aetna health plan! If you find that your new plan does not cover the medication you are taking, your doctor may request a medical exception to have you continue on your current therapy.

Clinical Policy Bulletins

Your plan uses Pharmacy Clinical Policy Bulletins as a guide for determining health care coverage. Here you can view our coverage policies for specific drugs. Be aware that Pharmacy Clinical Policy Bulletins are regularly updated and therefore may change over time. While Pharmacy Clinical Policy Bulletins are used as a guide, decisions regarding coverage are made on a case-by-case basis.

The Preferred Drug List includes preferred injectable medications. These are medications that you or your doctor injects to a specific part of the body. Visit Aetna Specialty Pharmacy or search the 2008 Aetna Specialty CareRx^SM List to learn more about these specialty medications.

* Rebates that Aetna receives from drug manufacturers do not reduce the amount you pay to the pharmacy for an individual prescription drug. If your copay is a percentage amount, it may be possible in some cases for your cost of a preferred drug to be higher than your cost of a non-preferred drug. Our online cost estimator tools on Aetna Navigator may help you decide which drug will cost you less.