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2022 Standard Opt Out Plan

You can find a list of the most commonly covered drugs under your plan (your formulary) below. After your effective date, just log in to your member website to check costs and coverage for a specific drug. 

 
 

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.

These drugs appear in the main list, but have been grouped into categories to make them easier to find.
 

HSA-associated plans: Prescription drugs on the Preventive list below will be covered as if you have already met your deductible. You are responsible only for your copay.
 

HRA-associated plans: Prescription drugs on the Preventive list and/or the Chronic list below could be covered as if you already met your deductible. You would be responsible only for your copay. To find out which lists apply to you, check your plan benefits documents.

 

Preventive Medicine List (PDF)

 

Chronic Medicine List (PDF)

 

Preventive drugs and products (PDF)

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 Medicine List (PDF)

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.

 

Preferred specialty drugs and formulary excluded specialty drugs (PDF)

Specialty drugs treat complex conditions that often require support by a nurse or pharmacist during treatment. These drugs may be injected, infused or taken orally and may require special handling

 

Aetna Value drug list fixed-rate copay (PDF)
Choosing a drug from this list will help you get the most value from your drug coverage.

 

Step Therapy Drug List

 

Preferred Generic Step Therapy (PDF)

High Performance Generic Step Therapy (PDF)

Traditional Generic Step Therapy (PDF)

Legal notices

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.