Your Pharmacy Benefits

Formulary
What is a formulary? It’s a list of drugs that can help you save money. We choose drugs for it that are safe and cost effective — they’re the drugs your health benefits or insurance plan prefers that you use. So when your doctor prescribes one of these drugs, it can help you control the cost of health care. Or lower the costs you pay out of pocket. The formulary includes both generic and brand-name drugs. Each drug is approved by the U.S. Food and Drug Administration (FDA). Any changes are based on the latest medical findings, as well as information from the FDA and drugmakers. You’re not limited to using formulary drugs. But you may save when you do. So talk with your doctor to see if one might be right for you. There are two ways to learn more about the formulary:

  • Aetna Preferred Drug (formulary) Guide: It gives you an overall view of the drugs your plan covers.
  • Aetna Preferred Drug (formulary) List: It lists recent changes to the guide. For example, it could show what drugs recently started to require, or no longer require, coverage reviews like precertification, step therapy or quantity limits.
To access this information, Click Here (PDF).

Other helpful information includes:


Skip the pharmacy line, and get your medicine by mail
Our mail-order pharmacies are also part of your benefits. These services are quick and private. You choose where your medicine is delivered — your home, your doctor’s office … wherever works for you. You get free standard shipping, too.


Enjoy two ways to get your medicine by mail:


Aetna Rx Home Delivery® mail-order pharmacy
Use this option if you take medicine on a regular basis for conditions like arthritis, asthma or diabetes.

  • Get up to 90 days’ worth of medicine, or the most allowed by your plan.
  • Pay less for that larger supply, depending on your plan.

Aetna Rx Home Delivery® medicine and support services
Use this option if you take specialty medicine for conditions like multiple sclerosis, rheumatoid arthritis or cancer.
  • Get this unique medicine packed safely and securely.
  • Receive tips and training on how to inject your medicine, if needed, and cope with side effects.
In addition to the three Never Event situations, the National Quality Forum (NQF) has released a list of twenty- five Serious Reportable Events. These are considered by NQF to be potentially avoidable conditions "which could reasonably have been prevented through application of evidence based guidelines". These conditions are not present when patients are admitted to a facility, but occur during the course of the stay.

How to order medicine, once you’re an enrolled member
Take these steps to submit new orders to Aetna Rx Home Delivery:

Step 1 Ask your doctor to write TWO prescriptions.

  • Prescription #1: Is for a one-month supply. Fill it at a local retail pharmacy. With this short-term supply you will have enough of your medicine on hand to see you through until your first Aetna Rx Home Delivery order arrives.
  • Prescription #2: Is typically for a 90-day supply (with three refills). Send this one to Aetna Rx Home Delivery.
Choose one of these ways to submit new orders to Aetna Specialty Pharmacy:
  • Fax - Your doctor may fax your prescription to 1-866-FAX-ASRX (1-866-329-2779).
  • Mail - You or your doctor may mail your prescription order to: Aetna Specialty Pharmacy, 503 Sunport Lane, Orlando, FL 32809. If you mail in your own prescription, please send it along with a completed Patient Profile Form. To access this form, visit www.aetnaspecialtyrx.com.
  • Phone - Your doctor may also call and speak to one of our registered pharmacists at 1-866-782-ASRX (1-866-782-2779) during our normal business hours of 8 a.m. until 7 p.m. ET.
Keep in mind
If you need a short-term supply of medicine: Just use a retail pharmacy near you. It’s easy to find one in our network — just log in to Aetna Navigator.

Not a member yet?
Take a test run by using “federal3” for the username and password.

These online tools are available to our members through Aetna Navigator:

  • Cost of Care Tool – find the average price for hospital stays, procedures and prescriptions.
  • Member Payment Estimator – provides real-time, out-of-pocket estimates for medical expenses based on your Aetna health plan.