Pharmacy Clinical Criteria - Pharmacy Clinical Policy Bulletins

Guides for prescription drug coverage

These guides help us make coverage decisions for members whose plans cover outpatient prescription drugs. They explain what drugs will be covered.

Pharmacy clinical policy bulletins and pharmacy clinical coverage criteria are highly technical. They are meant to be used by health care professionals.

These bulletins and criteria usually are for drugs that are on the Preferred Drug List, or require precertification or step therapy.

Aetna Commercial Prescription Drug Plans

2015 Coverage Criteria

Aetna Individual Formulary Prior Authorization and Step Therapy
Aetna Small Group Essential Formulary Precertification and Step Therapy
Aetna Premier and Premier Plus Formulary Precertification and Step Therapy
Aetna Value and Value Plus Formulary Precertification and Step Therapy 
Aetna Commercial Formulary for Fully Insured Plans
Aetna Commercial Formulary for Self-Insured Plans
Aetna Co-Pay Exception for Contraceptives Policy

Pharmacy Prescription Drug Prior Authorization Request Forms

Standard request form
California residents only
Colorado residents only

2014 Coverage Criteria

Search our 2014 Pharmacy Clinical Policy Bulletins (PCPBs) for Commercial Formulary Plans


2014 Health insurance exchange prescription drug plans

Find information about prescription drug plans offered on public exchanges.

Individual prior authorization criteria
Individual step-therapy criteria
Small group prior authorization criteria
Small group step-therapy criteria

2014 Aetna Commercial (non-Medicare) Prescription Drug Plans Formulary-2

Find information about drugs on this formulary.

2014 Aetna Commercial Formulary-2 prior authorization criteria
2014 Aetna Commercial Formulary-2 step-therapy criteria


Aetna Medicare prescription drug plans

We also provide information about our Medicare prescription drug plans.

See our Medicare information


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