This material is for information only. Aetna Specialty Pharmacy refers to Aetna Specialty Pharmacy, LLC, a subsidiary of Aetna Inc., which is a licensed pharmacy that operates through specialty pharmacy prescription fulfillment. The drugs on the Preferred Drug List Formulary Exclusions, Precertification, Quantity Limit and Step-Therapy Lists are subject to change. The precertification, quantity limits and step-therapy drug coverage review programs are not available in all service areas. For example, precertification and step therapy programs do not apply to fully insured members in Indiana. Step therapy does not apply to fully insured members in New Jersey. However, these programs are available to self-insured plans.
Making it easier to get your medicine
Once you’re an Aetna® member, you’ll get tools and resources to learn about your prescription coverage, estimate drug costs, find network pharmacies and more.
Need help?
Call an Aetna Concierge at 1-855-496-6289 (TTY: 711) Monday to Friday, 8 a.m. through 6 p.m. your local time. Or send us an email.
Learn about your formulary
Learn about your formulary
A formulary is a list of drugs covered under your plan, with details about the type of coverage. You may hear the word "formulary" during a visit with your doctor or when you pick up a prescription.
Does the formulary list every covered drug?
Your pharmacy benefits plan covers thousands of drugs — too many to list. So your main drug list will show only the most commonly prescribed drugs.
Have a medical need for a noncovered drug?
In certain circumstances*, you or your prescribing doctor can request a medical exception for a noncovered drug.
You have 3 ways to submit a request:
- Call our precertification department at 1-855-582-2025 (TTY: 711).
- Fax a request to 1-855-330-1716.
- 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 prescribing doctor of our decision.
Make the most of your prescription coverage
Your medicine is a big part of taking care of your health. That’s why you’re covered for most prescription drugs under the Advanced Control Plan — Aetna. You also get tools and information to help you make good decisions on costs and what’s best for you.
Find commonly covered drugs
It’s easy to find commonly covered drugs with our digital search tool. You can also browse the Aetna drug guide to find a comprehensive list.
Search to see if a drug is covered
Aetna drug guide (PDF)
Changes to this guide effective 1/1/22 (PDF)
Changes to this guide effective 4/1/22 (PDF)
Get some prescribed drugs for no cost
Health Care Reform drug list (PDF)
Under the Affordable Care Act, you can get the prescribed medicine you need for no cost-share. Some over-the-counter medications are included, too.
Estimate drug costs
You can check prescription costs to see how much your plan will cover and what you might have to pay out of pocket. You can even find the cost difference for choosing a brand-name drug versus a generic.
Get going
Download this PDF to see how Aetna can be the right health care company for you.
Ready to enroll?
Review the enrollment checklist with 4 to-dos before you choose a health plan.
*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 when you are undergoing a current course of treatment using a noncovered drug.
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).
This material is for information only and is believed to be accurate as of the production date; however, it is subject to change. Estimated costs are not available in all markets or for all services. We provide an estimate for the amount you would owe for a particular service based on your plan at that very point in time. It is not a guarantee. Actual costs may differ from an estimate for various reasons including claims processing times for other services, providers joining or leaving our network or changes to your plan. Health maintenance organization (HMO) members can only get estimated costs for doctor and outpatient facility services.
While only your doctor can diagnose, prescribe or give medical advice, the 24 Hour Nurse Line can provide information on a variety of health topics.
Health benefits and health insurance plans contain exclusions and limitations.