Skip to main content

Pharmacy FAQs

Frequently asked questions about pharmacy coverage

Choose a category below to see questions and answers about pharmacy coverage.

Drug coverage

Formulary (drug list)

Costs and reimbursement

Generic drugs

What are generic drugs?
Generic drugs contain the same active ingredients in the same amounts as the brand-name drugs and work the same way. They are proven to be just as safe and effective as brand-name drugs. So they have the same risks and benefits as brand-name drugs do. However, generic drugs typically cost less. When appropriate, your doctor may decide to prescribe a generic drug, or allow the pharmacist to substitute a generic drug. 

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

Compared with brand-name drugs, generic drugs may: 

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

What can I 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 without calling your doctor for approval. Doctors may write DAW if they believe the generic drug is not right for you. 

Precertification

Step therapy

Quantity limits

Home delivery

Specialty Pharmacy

Medical Exception

Medical Necessity Exceptions

In certain circumstances*, you or your prescriber can request a medical exception for a non-covered drug. To submit a request, call our Precertification Department at 1-855-582-2025, or fax a request to 1-855-330-1716. You also can mail a written request to CVS Health, ATTN: Aetna PA, 1300 E. Campbell Rd., Richardson, TX 75081. If the request is expedited a coverage determination will be made within 24 hours of receiving the request, and notify you or your prescriber of our decision. All medically necessary outpatient prescription drugs will be covered. If a medical exception is approved the member is responsible for the highest applicable copay after deductible depending upon the members pharmacy plan design.

*These circumstances exist when you are suffering from a health condition that may seriously jeopardize your life, health, or ability to regain maximum function, or undergoing a current course of treatment using a non-covered drug.

JavaScript is required

In order to have the best experience on Aetna.com, Javascript needs to be enabled.
Learn how to change your browser settings to enable Javascript.

You are now leaving the Aetna website

Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.

Continue