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More coverage details
Expedited medical 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 (TTY: 711), or fax a request to 1-855-330-1716. You also can mail a written request to Aetna PA, 1300 E. Campbell Rd., Richardson, TX 75081. We will make a coverage determination within 24 hours of receiving the request, and notify you or your prescriber of our decision.
*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.
Under health care reform, you can get some drugs and products with no member cost share. This means they are covered 100 percent by your plan. This list shows some common examples.
Maintenance Choice drug list includes drugs a person takes regularly to treat chronic conditions. For instance, arthritis, asthma, diabetes or high cholesterol. Check your plan benefit documents for details on filling a 90-day supply of drugs on this list.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).
CVS Specialty® and Aetna® are part of the CVS Health® family of companies. Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information. The drugs on the Preferred Drug List Formulary Exclusions, Precertification and Quantity Limit Lists are subject to change. The precertification and quantity limits drug coverage review programs are not available in all service areas. For example, precertification programs do not apply to fully insured members in Indiana. However, these programs are available to self-insured plans.
Health benefits and health insurance plans contain exclusions and limitations.
Questions about pharmacy coverage?
Find answers to common questions about policies, drug costs and more.