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2024 Standard Opt Out Plan

Let’s get to know your pharmacy plan. Use these resources to find a list of commonly covered prescription drugs — or search for a specific drug. Helpful information is here for you.

 

Have a member account? Log in to find cost and coverage information personalized for you.

You or your prescriber can request a medical exception if:

 

  • You have a health condition that may seriously jeopardize your life, health or ability to regain maximum function
  • You’re undergoing a current course of treatment using a non-covered drug

 

How to request a medical exception

Choose one of the following options:

 

  • Call our precertification team at 1-855-582-2025 ${tty}.
  • Fax your request to 1-855-330-1716.
  • Mail a written request to: Aetna PA, 1300 E. Campbell Rd., Richardson, TX 75081.

 

We’ll get in touch with you or your prescriber with a coverage decision within 24 hours of receiving your request.

These drugs appear in the main guide. We’ve grouped them into separate drug lists to help make them easier to find. For HSA and HRA plans, find coverage terms.*

 

Preventive medicine list (PDF) This list includes prescription drugs you might take to prevent the development of a health condition or disease. You get reduced out-of-pocket costs for the medicine you need.

 

Chronic medicine list (PDF) This list includes prescription drug you might take for an extended time period to treat a chronic condition. You get reduced out-of-pocket costs for the medicine you need.

 

Preventive drugs and products (PDF) Under health care reform, you can get some preventive drugs and products with no member cost share. This means they are covered 100% by your plan. This list shows some common examples. 

 

Maintenance medicine list (PDF) This list includes medicine you might take regularly to treat a chronic condition. For instance, arthritis, asthma, diabetes or high cholesterol. Check your plan documents for details on filling a 90-day supply of drugs on this list.

 

Exclusion drug list (PDF) This list shows drugs that aren’t covered by your plan. It also shows similar drugs with the same active ingredients that are covered by your plan.

 

Specialty drug list (PDF) This list includes specialty drugs which 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. This list shows preferred specialty drugs and specialty drugs excluded from the covered drug list, or formulary.

 

Value drug list (PDF) When you choose a drug from this list, you get a fixed-rate copay. This helps you get the most value from your drug coverage.

 

Step therapy

You may need to try one or more generic drugs before certain brand-name drugs are covered. This can help you save. This list provides examples of drugs that require step therapy and generic drug options.

 

Traditional generic step therapy list (PDF)

 

Preferred generic step therapy drug list (PDF)

 

High performance generic step therapy drug list (PDF)

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