Pharmacy FAQs

A formulary or preferred drug list (PDL) 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 Maryland uses a group of providers 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 Medicaid benefit policy.

Providers try to write for drugs on the drug list. Sometimes they write for drugs not on the list. Your provider may have forgotten which drugs are on your plan list. Providers may write for new drugs after a visit from a drug company representative. They may write for new drugs after seeing an ad. Some providers may write for drugs that they’ve 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 provider may write for any drug. Your provider can request a change from the drug list. Your provider must show that a drug not on the list is necessary to treat you in order for the drug to be covered.

Some drugs need preapproval because our providers feel they should only be used after other drugs have been tried first. Call Member Services at our toll-free number 1-866-827-2710, TTY 711.

The limits are reviewed and set by clinical staff.

The following drugs aren’t covered under the formulary:

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

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

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