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Pharmacy Clinical Programs

Address rising health costs and improve outcomes

Prepare your clients’ benefits for the future by controlling rising health care costs across both medical and pharmacy benefits.

We manage medication costs through a series of coordinated measures, such as encouraging the use of the most cost-effective medications wherever possible. To improve outcomes and minimize risk, we check each member's prescription for safety in real time.

Promoting preferred drugs

Members can save money when they and their doctors choose drugs on our Preferred Drug List.

Applying drug safety checks

Our precertification and step-therapy programs* help members stay safe by ensuring that drugs are appropriately prescribed. These programs also encourage members and doctors to consider drugs that cost less but are just as effective.

Spotting potential prescription errors

By analyzing pharmacy claims data, Aetna Rx Check® can reveal potential prescription errors or abuse and report them to doctors and members.

Identifying more drug issues

Drug interactions can pose serious health risks. Aetna MedQuery® uses our CareEngine® technology to identify drug interactions. We also look for drug-to-disease and drug-to-lab problems. We share our findings with the treating doctors to help improve patient care.


Proven results**:
  • We helped one customer increase generic use by 3.4% in only 6 months.
  • Members participating in the Suboxone Case Review Program had 35% fewer inpatient visits and 40% lower medical costs, compared with members who were not in the program.

*These drug coverage review programs may not apply in all service areas. Refer to your plan documents or call Member Services with any questions. For example, precertification, step therapy and quantity limits do not apply to fully insured HMO members in Indiana. Step therapy is also not available to fully insured members in New Jersey. However, these programs are available to self-funded plans in New Jersey and Indiana.

**Does not guarantee similar results for any particular employer. Results vary by plan design and programs selected. Savings also depend on the drugs used by employees.

The CareEngine is a proprietary technology platform developed by ActiveHealth Management, an Aetna company. In conjunction with clinicians, the CareEngine continuously analyzes claims and other data against evidence-based best practices and alerts the members and their physicians about possible care gaps and other inconsistencies. Information is not a substitute for diagnosis or treatment by a physician or other health care professional.

For complete information on plans and products, including availability, details and brochures, please contact Aetna.

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