All Aetna plans include prescription drug coverage. Some preventive medications [PDF] are not subject to the plan’s annual deductible, and some HCR essential prescribed medications [PDF] are available at no cost.
You pay the full, negotiated cost for other prescription drugs, which counts toward your annual deductible. Once you meet your deductible, you pay only a copay for covered medications. Prescription drug costs count toward your medical out-of-pocket maximum.
The list of medications covered by the plan is called the formulary. The Aetna formulary (Standard Opt Out Plan) shows whether a certain drug is covered as a generic, brand or nonpreferred brand. Check the Aetna website (SSO) or call the number on your member ID card for the cost of a specific drug.
For prescriptions up to 30 days, you can use any pharmacy in the network. To find one, log in to the Aetna website (SSO) and click the Pharmacy tab.
Copays for a 30-day supply: After you meet your plan’s deductible, you’ll pay $15 for generic drugs, $45 for brand-name drugs on the Aetna Performance Drug List and $65 for other brand-name drugs at a network pharmacy.
For medications you take regularly, you can receive a 90-day supply of maintenance drugs by mail-order service or at a CVS pharmacy for the same reduced price.
Copays for a 90-day supply: After you meet your plan’s deductible, you’ll pay $30 for generic drugs, $90 for brand-name drugs on the Aetna Performance Drug List and $130 for other brand-name drugs.
Use the CVS Specialty Pharmacy to fill your prescriptions for specialty medications. CVS Specialty offers personal support, helpful resources and free, secure home delivery.
Call 800-237-2767 with any questions about your specialty medication.