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 drug makers. Talk with your doctor to see if one might be right for you. Access this pharmacy information and other helpful links below:
View & download formulary lists:
Formulary list: All Aetna Federal plans (except Aetna Saver, Aetna Advantage, Aetna Medicare Advantage and MHBP Plans)
Download the 2023 Preferred Drug Guide (Formulary) (PDF)
- 2023 Specialty Drug List (PDF)
- 2023 Exclusions Drug List (PDF)
- 2023 Select over-the-counter (OTC) drug coverage (PDF)
- 2023 Preventive Care Drug List (PDF) Under health care reform, you can get some drugs and products with no member cost share. This means they are covered 100 percent by your plan. This list shows some common examples.
- 2023 Summary of Changes (PDF)
Formulary list: Aetna Saver and Aetna Advantage Federal plans (only)
Download the 2023 Preferred Drug Guide (Formulary) (PDF)
- 2023 Specialty Drug List (PDF)
- 2023 Exclusions Drug List not applicable due to closed formulary
- 2023 Select over-the-counter (OTC) drug coverage for this formulary includes only OTC Proton Pump Inhibitors (PPIs) and Non-Sedating Antihistamines (NSAs).
- 2023 Preventive Care Drug List (PDF) Under health care reform, you can get some drugs and products with no member cost share. This means they are covered 100 percent by your plan. This list shows some common examples.
- 2023 Summary of Changes (PDF)
Formulary list: Aetna Medicare Advantage Federal plan (only)
-
Under The Affordable Care Act, coverage of certain preventive services, including contraceptives, must be provided without member cost share. If your prescriber believes that a non-formulary contraceptive is medically necessary for you, your prescriber may request an exception. Please ask your provider to complete the Contraception Exception Form (PDF) to determine if the product is medically necessary. For more information on the Contraception Exception Process, please access this link (PDF).
You can learn more about contraception resources and reproductive rights at these websites: Please contact OPM if you have difficulty accessing contraceptive coverage or other reproductive health by contacting contraception@opm.gov.
Prescription Drug Cost Calculator Tools
Please use the Pharmacy cost calculator tools to get estimated costs for prescription drugs on certain Aetna Federal Plans.
Estimated costs are not available in all markets or for all products and services. We provide an estimate for the amount you would owe for a particular product or service based on your benefit plan and status 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 products and services, providers joining or leaving the network, changes in product availability, or changes to your benefit plan.
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:
1. CVS Caremark® Mail Service 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.
CVS Caremark® Mail Service pharmacy and Aetna are part of the CVS Health® family of companies.
2. CVS Specialty® 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.
CVS Specialty® and Aetna are part of the CVS Health® family of companies.
How to order medicine, once you’re an enrolled member
Take these steps to submit new orders to CVS Caremark Mail Service Pharmacy: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 CVS Caremark® Mail Service Pharmacy order arrives.
- Prescription #2: Is typically for a 90-day supply (with three refills). Send this one to CVS Caremark® Mail Service Pharmacy.
- Fax - Your doctor may fax your prescription to 1-800-323-2445
- Phone - Your doctor may also call and speak to one of our registered pharmacists at 1-800-237-2767 (TTY: 711) during our normal business hours of 7:30 AM to 9:00 PM ET.
- Online - You can visit CVSSpecialty.com and select Get Started. Enter your information, the name of the medication and your doctor’s contact information. The CVS Specialty® CareTeam will contact your doctor to get your prescription.
- CVS Retail Location - You also have the option of dropping your specialty prescription off at any CVS Pharmacy® location. It will be transferred to CVS Specialty and you will be contacted by a member of the CVS Specialty CareTeam.
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 your Aetna member website.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 member website:*
- 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.
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.
*If you proceed with the Cost of Care & Member Payment Estimator Tools pricing information is not guaranteed and is an estimate of the total cost. Please read the Plan’s Federal brochures to evaluate the cost of medical expenses. For additional information about prescription drugs, please refer to the Aetna Preferred Drug (formulary) Guide on AetnaFeds.com/pharmacy for more information.
