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2025 Standard Opt Out with ACSF 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 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.
  • 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.
  • 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.
  • Auto Immune Indication Based Medication (PDF) This list shows preferred option drugs for indication based self-administered autoimmune excluded drugs.

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