Pharmacy FAQ

A formulary is a list of drugs that a health plan covers. These drugs treat a variety of illnesses. We keep up to date on changes in drugs.

Aetna Better Health of California uses a group of doctors and pharmacists (P & T Committee) to make these choices. First, they get input from many doctors. Then, we choose the best drugs. Often, two drugs are equally safe and effective. There can be differences in their known benefits.

After a review, the committee may add drugs to the list. New drugs may be added every year. We try to remove drugs once a year. Some drugs are a benefit exclusion under the Medi-Cal benefit policy.

Doctors try to write for drugs on the drug list. Sometimes they write for drugs not on the list. Your doctor may have forgotten which drugs are on your plan list. Doctors may write for new drugs after a visit from a drug company representative.  They may write for new drugs after seeing an ad.  Some doctors may write for drugs that they have used for a long time although different drugs may be on the drug list.  We make sure that the best drugs are on our drug list. You can find updated lists on this website and in our member newsletter. 

Your doctor may write for any drug. Your doctor can request a change from the drug list. Your doctor must show that a drug not on the list is necessary to treat you in order for the drug to be covered. 

If your medicine is not on the formulary, there are some things you can do.

  • Ask your provider for a similar drug that is on the list.
  • Ask your provider to seek pre-approval from Aetna Better Health of California to cover this medicine. Your provider knows how to do this.

Some drugs need pre-approval because our doctors feel they should only be used after other drugs have been tried first. For more information call Member Services at our toll-free number 1-855-772-9076, TTY 711.

Quantity limits are set on drugs for different reasons. Limits are set because some drugs have a maximum limit or a maximum dose for safety reasons.

The limits are reviewed and set by clinical staff. 

Your doctor can contact us so our pharmacy staff can review the medical information provided by your doctor and decide if they will make an exception.

The following drugs are not covered under the formulary:

  • Medications for cosmetic use
  • Hair growth agents
  • Drugs to treat infertility or erectile dysfunction
  • Experimental or investigational medications