Under the Aetna plans, prescription drugs are covered according to which medical plan you enroll in.
For the HealthSave and HealthSave Basic plans, for some preventive medications [PDF], you pay only your copay or coinsurance, with no deductible. And some essential medications [PDF] are available at no cost to you. For all other drugs, you pay the full, negotiated cost, which counts toward your annual deductible and your out-of-pocket maximum.
For the HealthSave EPO plan, you must use a participating network pharmacy. You pay only your copay for drugs, with no deductible There is no coverage for drugs obtained at a nonparticipating pharmacy.
For the cost of a specific drug, log in to the Aetna website (or SSO), or call Aetna at 800-884-9565.
Drug copays at a glance
Your cost depends on your plan, the supply you receive, and the type of drug, as listed on the Aetna Standard drug coverage page. For HealthSave and HealthSave Basic participants, copays apply after the deductible is met. For HealthSelect EPO participants, copays apply immediately because the plan does not have a deductible. Drugs are categorized as generic, preferred brand, or nonpreferred brand.
Note that the Aetna drug coverage page may list medications that are not covered by our plan. Certain medications may require prior authorization before coverage is approved. In some cases, you may also be asked to try a lower-cost medication before a higher-cost alternative is covered. See the plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage.
You are be able to log in to your Aetna member account to find 2026 drug cost and coverage information personalized to you.
| HealthSelect EPO | HealthSave | HealthSave Basic | |
|---|---|---|---|
| 30-day supply, in-network retail | $15 generic $45 preferred brand $65 nonpreferred drugs (no deductible) | After deductible: $15 generic $45 preferred brand $65 nonpreferred drugs | After deductible: $15 generic $45 preferred brand $65 nonpreferred drugs |
| 90-day supply, in-network retail or mail order | $30 generic $90 preferred brand $130 nonpreferred drugs (no deductible) | After deductible: $30 generic $90 preferred brand $130 nonpreferred drugs | After deductible: $30 generic $90 preferred brand $130 nonpreferred drugs |
Beginning January 1, 2027, if you choose a brand-name drug when a generic equivalent is available, you’ll pay the price difference in addition to your copay unless your doctor indicates dispense as written (DAW). This difference in price does not count toward your deductible or out-of-pocket maximum.
Specialty medications
For drugs designated on the drug coverage page as specialty drugs, use the CVS Specialty Pharmacy to fill your prescription. Call 800-237-2767 with any questions about your specialty medication.
Lower costs for some specialty medications
Certain specialty drugs may be eligible for the PrudentRx program. PrudentRx uses manufacturer coupon programs to help reduce or eliminate your out-of-pocket costs for certain specialty medications, after you meet your deductible (if applicable). If your medication is eligible for this program, you'll be contacted by PrudentRx.
There are two important things to keep in mind:
- Starting in 2027, only the amount you personally pay out of pocket will count toward your deductible and out-of-pocket maximum; manufacturer coupon dollars will not.
- If you opt out of the PrudentRx program, you’ll pay 30% of the total drug cost (once any applicable deductible is met) instead of your standard copay, and that full amount will count toward your out-of-pocket maximum.
Here’s what you’ll pay depending on whether you participate.
| Aetna HealthSave and HealthSave Basic | Aetna HealthSelect EPO | |
|---|---|---|
| Enrolled in PrudentRx | $0 once your deductible is met | $0; no deductible applies |
| Opt out of PrudentRx | 30% of the total drug cost once your deductible is met | 30% of the total drug cost; no deductible applies |