Pharmacy Benefits

Whether it’s pain medication after an injury or medication to manage a health condition, getting the prescription drugs you need is an important part of your health care. We want to make it as easy for you as possible. If you have any questions, please call Member Services at 1-866-827-2710, TTY 711.

Notice to Members

Effective 01/01/2020, medications for HIV are now processed by Aetna Better Health of Maryland.  Please present your Aetna Better Health of Maryland card to your pharmacy for these medications.

If you need medicine, your provider will choose a drug from our list of preferred drugs.

  • Your provider will write you a prescription. Ask your provider to make sure that the medicine is on our list.
  • Take your prescription to a pharmacy that’s in our network.
  • Show your Aetna Better Health of Maryland member ID card at the pharmacy.

Sometimes your provider will want to give you a drug that’s not on our list or that’s a brand name drug. Your provider may feel you need a medicine that is not on our list because you can’t take any other drugs except the one prescribed. Your provider can request approval from us. Your provider knows how to do this.

Take all of your prescriptions to one of our network pharmacies. Show your Aetna Better Health of Maryland member ID card at the pharmacy. We will pay for some drugs that you can get without a prescription when your provider asks us.

Check the list of network pharmacies and look for one in your area. If you need help, just call Member Services at 1-866-827-2710, TTY 711. They’ll be glad to help you find a network pharmacy near you. You can also find a pharmacy via our secure member portal.

Always remember to fill your prescription at a network pharmacy. Your prescriptions won’t be covered at other pharmacies.

To prevent extra costs, check that your medicines are on the preferred drug list. This is called the formulary. If you have questions, just call Member Services at 1-866-827-2710, TTY 711. Have a list of your prescriptions ready when you call. Ask us to look up your medicines to see if they’re on the list.

You can also view the preferred drug list via our formulary search tool. Searches can be performed by drug name or by drug class. The tool will provide formulary status, generic alternatives and if there are any clinical edits (prior authorization, quantity limits, age limits etc.)

Updates are made regularly to the Aetna Better Health formulary and can be viewed below and through the formulary search tool. Formulary changes to identify include:

  • Addition/removal of a drug from the formulary
  • Addition/removal of quantity limits
  • Addition/removal of prior authorization requirements

If your medicine isn’t on the preferred drug list/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 “exception request” (pre-approval) from Aetna Better Health of Maryland to cover this medicine. Your provider knows how to do this.

April 2020

Additions:

  • Mesalamine ER Cap 0.375gm (Quantity Level Limit)
  • Penicillamine Tab 250mg (Prior Authorization Required, Quantity Level Limit)

Removals:

  • Apriso ER Cap 0.375gm (Brand)

 

March 2020

Removals:

  • Carboxymethylcellulose Sodium Ophthalmic Solution 1%
  • Corn Starch Topical Powder
  • Hydrocodone-Acetaminophen Solution 10-325mg/10ml
  • Lidocaine Hydrochloride Gel 2%
  • Sodium Fluoride Rinse 0.2%
  • Sodium Fluoride Solution 0.125mg/drop

 

February 2020

Additions:

  • Bimatoprost Ophthalmic Solution 0.03% (Step Therapy Required)
  • Ethinyl Estradiol – Etonogestrel Ring 0.015/0.12mg (Quantity Level Limit)
  • Everolimus Tabs 2.5mg, 5mg, 7.5mg (Prior Authorization Required, Quantity Level Limit)
  • Removals:
  • Afinitor Tabs 2.5mg, 5mg, 7.5mg (Brand)
  • Chlorothiazide Tabs 250mg, 500mg
  • Demeclocycine Tabs 150mg, 300mg
  • Doxycycline Monohydrate Tab 150mg
  • First-Vanco Solution 25mg/ml, 50mg/ml
  • Homatropoine Ophthalmic Solution 5%
  • Kyleena IUD
  • Methylclothiazide Tab 5mg
  • Mirena IUD
  • Nausea Relief Liquid
  • Nizatidine Solution 15mg/ml
  • Nuvaring (Brand)
  • Phospholine Ophthalmic Solution 0.125%
  • Propantheline Cap 15mg
  • Rabeprazole EC Cap 20mg
  • Ranitidine Caps 150mg, 300mg
  • Skyla IUD

Other Updates:

  • Atropine Ophthalmic Ointment 1% (Quantity Level Limit)
  • Atropine Ophthalmic Solution 1% (Quantity Level Limit)
  • Combigan Ophthalmic Solution 0.2/0.5% (Quantity Level Limit)
  • Dorzolamide-Timolol Ophthalmic Solution 22.3-6.5% (Step Therapy Required, Quantity Level Limit)
  • Doxycycline Monohydrate Suspension 25mg/5ml (Age Limit)
  • Granisetron Tab 1mg (Step Therapy Required)
  • Ibandronate Injection 3mg/3ml (Quantity Level Limit)
  • Levofloxacin Ophthalmic Solution 0.5% (Quantity Level Limit)
  • Memantine Tabs 5mg, 10mg (Quantity Level Limit)
  • Methazolamide Tabs 25mg, 50mg (Step Therapy Required)
  • Natacyn Ophthalmic Suspension 5% (Quantity Level Limit)
  • Tazarotene Cream 0.1% (Step Therapy Required)
  • Trifluridine Ophthalmic Solution 1% (Quantity Level Limit)

 

January 2020

Additions:

  • Abacavir Solution 20mg/ml (Prior Authorization Required, Quantity Level Limit)
  • Abacavir Tab 300mg (Prior Authorization Required, Quantity Level Limit)
  • Abacavir-Lamivudine Tab 600-300mg (Prior Authorization Required, Quantity Level Limit)
  • Abacavir-Lamivudine-Zidovudine Tab 300-150-300mg (Prior Authorization Required, Quantity Level Limit)
  • Aptivus Cap 250mg (Prior Authorization Required, Quantity Level Limit)
  • Aptivus Solution 100mg/ml (Prior Authorization Required, Quantity Level Limit)
  • Atazanavir Sulfate Caps 150mg, 200mg, 300mg (Prior Authorization Required, Quantity Level Limit)
  • Atripla Tablet (Prior Authorization Required, Quantity Level Limit)
  • Biktarvy Tab 50-200-25mg (Prior Authorization Required, Quantity Level Limit)
  • Complera Tab (Prior Authorization Required, Quantity Level Limit)
  • Crixivan Caps 200mg, 400mg (Prior Authorization Required, Quantity Level Limit)
  • Descovy Tab 200-25mg (Prior Authorization Required, Quantity Level Limit)
  • Didansoine DR Caps 250mg, 400mg (Prior Authorization Required, Quantity Level Limit)
  • Edurant Tab 25mg (Prior Authorization Required, Quantity Level Limit)
  • Efavirenz Caps 50mg, 200mg (Prior Authorization Required, Quantity Level Limit)
  • Efavirenz Tab 600mg (Prior Authorization Required, Quantity Level Limit)
  • Emtriva Cap 200mg (Prior Authorization Required, Quantity Level Limit)
  • Emtriva Solution 10mg/ml (Prior Authorization Required, Quantity Level Limit)
  • Fosamprenavir Tab 700mg (Prior Authorization Required, Quantity Level Limit)
  • Fuzeon Vial 90mg (Prior Authorization Required, Quantity Level Limit)
  • Genvoya Tab (Prior Authorization Required, Quantity Level Limit)
  • Intelence Tabs 25mg, 100mg, 200mg (Prior Authorization Required, Quantity Level Limit)
  • Invirase Tab 500mg (Prior Authorization Required, Quantity Level Limit)
  • Isentress Chew Tab 25mg, 100mg (Prior Authorization Required, Quantity Level Limit)
  • Isentress HD Tab 600mg (Prior Authorization Required, Quantity Level Limit)
  • Isentress Tab 400mg (Prior Authorization Required, Quantity Level Limit)
  • Juluca Tab 50-25mg (Prior Authorization Required, Quantity Level Limit)
  • Kaletra Tabs 100-25mg, 200-50mg (Prior Authorization Required, Quantity Level Limit)
  • Lamivudine Solution 10mg/ml (Prior Authorization Required, Quantity Level Limit)
  • Lamivudine Tabs 150mg, 300mg (Prior Authorization Required, Quantity Level Limit)
  • Lamivudine-Zidovudine Tab 150-300mg (Prior Authorization Required, Quantity Level Limit)
  • Lexiva Suspension 50mg/ml (Prior Authorization Required, Quantity Level Limit)
  • Lopinavir-Ritonavir Tab 80-20mg (Prior Authorization Required, Quantity Level Limit)
  • Nevirapine ER Tabs 100mg, 400mg (Prior Authorization Required, Quantity Level Limit)
  • Nevirapine Suspension 50mg/5ml (Prior Authorization Required, Quantity Level Limit)
  • Nevirapine Tab 200mg (Prior Authorization Required, Quantity Level Limit)
  • Norvir Powder Packet 100mg (Prior Authorization Required)
  • Norvir Solution 80mg/ml (Prior Authorization Required, Quantity Level Limit)
  • Odefsey Tab (Prior Authorization Required, Quantity Level Limit)
  • Prezista Suspension 100mg/ml (Prior Authorization Required, Quantity Level Limit)
  • Prezista Tabs 75mg, 150mg, 800mg (Prior Authorization Required, Quantity Level Limit)
  • Rescriptor Tab 200mg (Prior Authorization Required, Quantity Level Limit)
  • Ritonavir Tab 100mg (Prior Authorization Required, Quantity Level Limit)
  • Selzentry Tabs 25mg, 75mg, 150mg, 300mg (Prior Authorization Required, Quantity Level Limit)
  • Stavudine Caps 15mg, 20mg, 30mg, 40mg (Prior Authorization Required, Quantity Level Limit)
  • Stribild Tab (Prior Authorization Required)
  • Symfi Lo Tab 400-300-300mg (Prior Authorization Required, Quantity Level Limit)
  • Symfi Tab 600-300-300mg (Prior Authorization Required, Quantity Level Limit)
  • Symtuza Tab 800-150-200-10mg (Prior Authorization Required, Quantity Level Limit)
  • Tenofovir Disop Fum Tab 300mg (Prior Authorization Required, Quantity Level Limit)
  • Tivicay Tabs 10mg, 25mg, 50mg (Prior Authorization Required, Quantity Level Limit)
  • Triumeq Tab 600-50-300mg (Prior Authorization Required, Quantity Level Limit)
  • Truvada Tabs 100-150mg, 200-300mg (Prior Authorization Required, Quantity Level Limit)
  • Truvada Tabs 133-200mg, 167-250mg (Prior Authorization Required)
  • Videx Pediatric Solution 2gm, 4gm (Prior Authorization Required, Quantity Level Limit)
  • Viracept Tabs 250mg, 625mg (Prior Authorization Required, Quantity Level Limit)
  • Viread Powder (Prior Authorization Required, Quantity Level Limit)
  • Viread Tabs 150mg, 200mg, 250mg (Prior Authorization Required, Quantity Level Limit)
  • Zidovudine Cap 100mg (Prior Authorization Required, Quantity Level Limit)
  • Zidovudine Syrup 50mg/5ml (Prior Authorization Required, Quantity Level Limit)
  • Zidovudine Tab 300mg (Prior Authorization Required, Quantity Level Limit)

     Removals:

  • Ventolin HFA Inhaler (Brand removed)

 

December 2019

Removals:

  • Aminocaproic Acid Solution 0.25gm/ml
  • PreNata Chewable Tab 29-1mg
  • Digoxin Tabs 62.5mcg, 187.5mcg

 

November 2019

Additions:

  • Aminocaproic Acid Solution 0.25gm/ml

 

 

October 2019

No Updates

 

 

September 2019

Additions:

  • Ambrisentan Tabs 5mg, 10mg (Prior Authorization Required, Quantity Level Limit)
  • Bosentan Tabs 62.5mg, 125mg (Prior Authorization Required, Quantity Level Limit)
  • Febuxostat Tabs 40mg, 80mg (Step Therapy Required)

Removals:

  • Letairis Tabs 5mg, 10mg (Brand)
  • Tracleer Tabs 62.5mg, 125mg (Brand)
  • Uloric Tabs 40mg, 80mg (Brand)

 

August 2019

Additions:

  • Aspercreme with Lidocaine 4% (Quantity Level Limit)
  • Butenafine HCl Cream 1%
  • Fulphila Injection 6mg/0.6ml (Prior Authorization Required)
  • Nivestym Injection 300mcg, 480mcg (Prior Authorization Required)

Removals:

  • Butalbital-Acetaminophen-Caffeine Capsules 50-300-40mg, 40-325-40mg
  • Calcium Acetate Oral Solution 667mg/5ml
  • Ciclopirox Gel 0.77%
  • Colestipol HCl Granule Packets 5gm
  • Entecavir Oral Solution 0.05mg/ml
  • Epinastine HCl Ophthalmic Solution 0.05%
  • Erythromycin Ethylsuccinate Suspension 200mg/5ml, 400mg/5ml
  • Esterified Estrogens Tabs 0.3mg, 0.625mg, 1.25mg
  • Estradiol Tab 1mg (15)/Estradiol-Norgestimate Tab 1-0.09mg(15)
  • Etodolac ER Tab 400mg, 500mg, 600mg
  • Lindane Shampoo 1%
  • Moexipril HCl Tabs 7.5mg, 15mg
  • Olopatadine HCl Ophthalmic Solution 0.2%
  • Quinidine Gluconate CR Tab 324mg

Other Updates:

  • Azelastine HCl Ophthalmic Solution 0.05% (Quantity Level Limit)
  • Calcipotriene Cream 0.005% (Prior Authorization Required, Quantity Level Limit)
  • Calcipotriene Ointment 0.005% (Prior Authorization Required, Quantity Level Limit)
  • Calcipotriene Solution 0.005% (Prior Authorization Required, Quantity Level Limit)
  • Ciclopirox Olamine Cream 0.77% (Step Therapy)
  • Ciclopirox Olamine Suspension 0.77% (Step Therapy)
  • Ciclopirox Shampoo 1% (Step Therapy)
  • Clotrimazole (RX) Solution 1% (Step Therapy)
  • Estradiol Vaginal Tablet 10mcg (Quantity Level Limit)
  • Fluocinolone Acetonide Cream 0.025% (Quantity Level Limit)
  • Fluocinolone Acetonide Ointment 0.025% (Quantity Level Limit)
  • Ketoconazole Cream 2% (Step Therapy, Quantity Level Limit)
  • Lidocaine HCl Gel 2% (Quantity Level Limit)
  • Lidocaine-Prilocaine Cream 2.5-2.5% (Quantity Level Limit)
  • Liothyronine Sodium Tabs 5mcg, 50mcg (Quantity Level Limit)
  • Norethindrone Tab 5mg (Step Therapy)
  • Thyroid Tabs 15mg, 30mg, 60mg, 90mg, 120mg, 180mg, 240mg, 300mg (Quantity Level Limit)

 

July 2019

Additions:

  • Mesalamine Cap 400mg DR (Quantity Level Limit)
  • Cefixime Cap 400mg (Quantity Level Limit)
  • Erlotinib Tab 150mg (Quantity Level Limit, Prior Authorization Required)

Removals:

  • Suprax Cap 400mg
  • Tarceva Tab 150mg

Other Updates:

  • None

 

June 2019

Additions:

  • Docosanol Cream 10%

Removals:

  • Abreva Cream 10%

Other Updates:

  • None

 

May 2019

Additions:

  • Erythrom Eth Sus 400/5ml
  • Nivestym Inj (Prior Authorization Required)
  • Sirolimus Sol 1mg/ml

Removals:

  • EryPed 400 Sus 400/5ml
  • Rapamune Sol 1mg/ml

Other Updates:

  • All short-acting opioids (7 day supply limit if opioid naïve)

 

April 2019

Additions:

  • None

Removals:

  • Norethin Acet & Estrad-FE (24)

Other Updates:

  • Butalbital-Acetaminophen Tab 50-325mg (Quantity Level Limit)
  • Butalbital-Acetaminophen-Caffeine Cap 50-300-40mg, 50-325-40mg (Quantity Level Limit)
  • Butalbital-Acetaminophen-Caffeine Tab 50-325-40mg (Quantity Level Limit)
  • Butalbital-Acetaminophen-Caffeine w/ Codeine Cap 50-300-40-30mg       (Quantity Level Limit)
  • Butalbital-Acetaminophen-Caffeine w/ Codeine Cap 50-325-40-30mg (Quantity Level Limit)
  • Butalbital-Acetaminophen-Caffeine w/ Codeine Cap 50-325-40-30mg (Quantity Level Limit)
  • Butalbital-Aspirin-Caffeine Cap 50-325-40mg (Quantity Level Limit)
  • Butalbital-Aspirin-Caffeine w/ Codeine Cap 50-325-40-30mg (Quantity Level Limit)

 

March 2019

Additions:

  • Albuterol Aer HFA (Quantity Level Limit)
  • Toremifene Citrate 60mg Tab
  • Mesalamine 100mg Supp (Quantity Level Limit)
  • Admelog Sol 100units

Removals:

  • Ventolin HFA
  • Fareston 60mg Tab
  • Canasa 100mg Supp
  • Humalog Sol 100units

Aetna Better Health also covers certain over-the-counter drugs, if they’re on our list. Some are covered, under certain rules. If the rules for that drug are met, Aetna Better Health will cover the drug. Like other drugs, over-the-counter drugs must have a prescription from a provider for them to be covered at no cost to you.

You can look to see if your over-the-counter medicines are on our formulary. You can also check with Member Services at 1-866-827-2710, TTY 711. When you call, have a list of your over-the-counter medicines ready. Ask the representative to look up your medicines to see if they’re on the list.

Aetna Better Health Specialty Drugs are filled by CVS Specialty Pharmacy. A specialty pharmacy fills drugs and has other services to help you. The Specialty Drug Program has special services for you:

  • You can talk to a pharmacist 24 hours a day, seven days a week
  • Counseling about your drug and disease
  • Coordination of care with you and your doctor
  • Delivery of Specialty drugs to your home or doctor’s office
  • You can drop off your prescription and pick up your drug at any CVS Pharmacy (including those inside Target stores)

You can call CVS Specialty Pharmacy at 1-800-237-2767; TTY/TDD: 1-800-863-5488. CVS Specialty Pharmacy will help you with filling your specialty drug. The specialty drug list lists all the specialty drugs available.

View our Frequently Asked Questions for answers to common questions.

 

Managing a medication routine that requires you to take multiple drugs at different times can be a challenge. With CVS Pharmacy®, you can take advantage of the convenience of having your medications organized for you by day and time of dose with Multi-Dose Packaging.

Multi-Dose Packaging or “MDP,” can help you take medications as prescribed, and reduces the confusion and the stress of managing a complex daily schedule of drugs and dosages.

Personalized

Each order is custom-filled and individually labeled just for you with your medications name, description and dosage.

Organized by date and time

Each pack is clearly marked with the date, day of the week and simple icons telling you when to take your next dose.

Timesaving

Your 30-day supply of multi–dose packs means fewer trips to the pharmacy and less time organizing multiple bottles and pill boxes.

Convenient

The dispenser box holds all your medications in one place. Work, travel or on the go, packs are easy to take along with you.

How does MDP work?                                

  • MDP organizes your medications for you in one continuous strip of personalized 30-day packs, labeled and in order by the date and time of day they should be taken
  • When you’re due for your next dose, simply tear your next scheduled pack(s) from the strip and take your medications as directed
  • Individual packs are stored in a convenient dispenser box, and can be shipped directly to your home or to the CVS Pharmacy® of your choice for pick up
  • There is no additional cost for MDP or for home delivery1

 Sign up today!

 Here is what you’ll need to get started:

  1. Your list of medications with prescriber information
  2. The location (s) of where you currently fill your prescriptions
  3. Billing/insurance information

 

*Multi-Dose packaging is provided without additional fees. Drug costs may change when prescriptions are transferred to a new pharmacy or change from a 90-day prescription to a 30-day prescription. To align prescriptions on a 30-day cycle, 1 or more additional co-pays may be required by the patients plan. Not all medications can be included in the Multi-Dose packs. Please contact your CVS Pharmacy team for additional information.

**Available 24/7 in select states and stores.

© 2018 CVS Pharmacy, Inc.

If you take medicine for an ongoing health condition, you can have them mailed to your home. Aetna Better Health works with a company called CVS Caremark, to give you this service which is available at no cost to you. If you choose this option, your medicine comes right to your home. You can set up your refills. You can ask pharmacists questions.

Here are some other features of home delivery:

  • Pharmacists check each order for safety.
  • You can order refills by mail, by phone, online, or you can sign up for automatic refills.
  • You can talk with pharmacists by phone.

It’s easy to start using mail service
Choose ONE of the following three ways to use mail service for a medicine that you take on an ongoing basis:

  • Call the CVS toll-free number at 1-855-271-6603, TTY 711 (24 hours a day, 7 days a week). They will let you know which of your medicines can be filled through CVS mail service pharmacy. CVS will then contact your doctor for a prescription and mail the medicine to you. When you call, be sure to have:
    • Your Plan member ID card
    • Your doctor’s first and last name and phone number
    • Your payment information and mailing address
  • Go to our member portal to register or login. Once you enter the member portal, go to Caremark.com. Click on start mail service to register to print off the mail order form or you can contact CVS at 1-855-271-6603. Be sure to have your member ID card handy when you register for the first time.
  • Fill out and send a mail service order form. If you already have a prescription, you can send it to CVS Caremark with a completed mail service order form. If you don’t have an order form, you can download it. You can also request one by calling Member Services at 1-866-827-2710, TTY 711.

Have the following information with you when you complete the form:

    • Your Plan member ID card
    • Your complete mailing address, including ZIP code
    • Your doctor’s first and last name and phone number
    • A list of your allergies and other health conditions
    • Your original prescription from your doctor.

CVS Mail-Order Service Form

Your medicine bottle label says how many refills you can have. If your provider hasn’t ordered refills, and you think you need one, you must call him or her a few days before your medicine runs out. When you call, ask your provider about getting a refill. He or she may want to see you first.