Aetna Better Health’s Formulary Drug Lists


Medicaid Members

When considering medications, you and your doctor should try to use drugs that are designated as preferred on the Statewide Preferred Drug List (PDL).  Drugs designated as non-preferred on the PDL remain available to you when determined to be medically necessary through the prior authorization process.  The Pennsylvania Department of Human Services (DHS) also provides a search tool.  To see any Quantity Level Limits (QLL), please check the QLL Document.

Aetna Better Health of Pennsylvania also covers drugs and products that are not on the DHS PDL.  This is called the Supplemental Formulary.  Click here to look at this list or use our Supplemental Formulary Search Tool.


Aetna Better Health Kids

To prevent extra costs, check that your medicines are on the preferred drug list.  This list is called the formulary.

To view medicines that are covered on the formulary, you can search for drugs using our Formulary Search Tool.  Searches can be performed by drug name or drug class.  The tool will provide formulary status and if there are any clinical edits (Prior Authorization, Quantity Level Limits, Age Limits, etc.).


All Members

The formularies can change.  You can see a list of added or removed drugs by reading the formulary updates below.

Ask your doctor to review the Formulary Drug List for any restrictions or recommendations regarding prescription drugs before prescribing a drug for you. Then, make sure you get your prescriptions filled at an Aetna Better Health network pharmacy. The Member Handbook tells you how much you have to pay for your medicines based on your pharmacy benefit.

You can learn about potential drug interactions, side effects and risks of the medicines you take. Just visit Krames Online and MedlinePlus.

Find a pharmacy provider

You can find the location of an in-network pharmacy by visiting the CVS Caremark pharmacy locator. This allows you to search for a pharmacy by zip code so you can find a location close to you.

Other drug lists

Careful handling and quick delivery for specialty drugs

Our preferred Specialty Pharmacy providers are Accuserv Pharmacy, Caremark Specialty Pharmacy, Einstein at Center One Pharmacy, Elwyn Specialty Care, Giant Eagle Pharmacy, Pharmblue LLC and Senderra Rx Pharmacy.

These pharmacies fill prescriptions for Specialty Drugs .* These types of drugs may be injected, infused or taken by mouth. Usually, you can't get these drugs at a local retail pharmacy. They often need special storage and handling. And they need to be delivered quickly.

Our preferred Specialty Pharmacies provide many helpful services, including:

  • Free, secure delivery (usually within 48 hours of confirming your order)
  • Delivery to your home, doctor’s office or any other place you choose
  • Package tracking for prompt delivery
  • Training on how to self-inject your medicine
  • Free injection supplies, such as needles, syringes, alcohol swabs, adhesive bandages and containers for needle waste

How to get started

We have several ways for you to fill a prescription through one of our preferred Specialty Pharmacies.

Existing prescriptions: To transfer an existing prescription, call one of our Preferred Specialty pharmacies.

New prescriptions: For a new prescription, your doctor can:

  • Send a prescription electronically.
  • Fax your prescription
  • Call one of preferred specialty pharmacies
  • You or the doctor can mail the prescription order.

After the pharmacy receives your prescription, your first order should ship within 48 hours. It may take longer if they need to contact your doctor about the prescription. 

Accuserv Pharmacy

Caremark Specialty Pharmacy

Einstein at Center One Pharmacy

Elwyn Specialty Care

Giant Eagle Pharmacy

Pharmblue LLC

  • You or your doctor can visit the web site for an enrollment form:
  • Phone: 855-779-4720
  • Fax: 844-818-7550

Senderra Rx Pharmacy

A personal care plan and ongoing support

Each of our preferred Specialty Pharmacies has a team of experienced nurses and pharmacists to help you understand how to use your medicine. They can answer your questions and help you cope with your condition throughout your therapy.

You can talk to them 24 hours a day, 7 days a week.

Get extra support for your complex medical condition

Skilled nurses and pharmacists offer extra support to patients with complex medical conditions, such as the any of the following:

  • Anemia
  • Asthma
  • Cancer
  • Chronic renal failure
  • Crohn's disease
  • Gaucher disease
  • Growth hormone deficiency
  • Hematologic conditions
  • Hemophilia
  • Hepatitis
  • Immune system disorders
  • Multiple sclerosis
  • Neurologic conditions
  • Osteoarthritis
  • Psoriasis
  • Pulmonary diseases
  • Respiratory syncytial virus (RSV)
  • Rheumatoid arthritis
  • Transplant

Joining our preferred Specialty Pharmacy network

Are you a pharmacy interested in joining our preferred specialty pharmacy network? You can get the application process started by sending an email to Thank you for your interest in supporting our commitment to high-quality care.

Updates are made regularly to the Statewide Preferred Drug List.

Medicaid Supplemental Formulary Updates

Formulary changes include the following:

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


February 2020

No Updates


January 2020


  • Aspirin EC Tabs 81mg, 325mg
  • Aspirin Tabs 81mg, 325mg
  • BD Pen Needles
  • Lancets, Lancet Kits, Lancet Devices
  • Tums Chewable Tabs 500mg, 750mg, 1000mg (Brand Name)


  • Hydrocortisone Rectal Cream 1%
  • Omega-3 Fatty Acids Cap 1400mg


February 2020


  • Bimatoprost Ophthalmic Solution 0.03% (Step Therapy Required)
  • Ethinyl Estradiol – Etonogestrel Ring 0.015mg-0.12mg (Quantity Level Limit)
  • Everolimus Tabs 2.5mg, 5mg, 7mg (Prior Authorization Required)


  • Afinitor Tab 2.5mg, 5mg, 7.5mg (Brand)
  • Alprazolam Concentrate Solution 1mg/ml
  • Chlorothiazide Tabs
  • Demeclocycline Tabs
  • Doxycycline Monohydrate Tab 150mg
  • First-Vanco Solution 25mg/ml, 50mg/ml
  • Homatropine 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)
  • Buspirone Tabs 5mg, 7.5mg, 10mg, 15mg (Age Limit)
  • Combigan Ophthalmic Solution 0.5/0.5% (Quantity Level Limit)
  • Diazepam Concentrate 5mg/ml (Quantity Level Limit)
  • Diazepam Oral Solution (Quantity Level Limit)
  • Diazepam Tabs 2mg, 5mg, 10mg (Quantity Level Limit)
  • Divalproex ER Tab 250mg, 500mg (Prior Authorization Required)
  • Dorzolamide-Timolol Ophthalmic Solution 22.3-6.8% (Quantity Level Limit)
  • Doxycycline Monohydrate Suspension 25mg/5ml (Age Limit)
  • Granisetron Tab 1mg (Step Therapy Required)
  • Hydroxyzine Pamoate Caps 25mg, 50mg, 100mg (Quantity Level Limit)
  • Hydroxyzine Syrup 10mg/5ml (Quantity Level Limit)
  • Hydroxyzine Tab 50mg (Quantity Level Limit)
  • Levofloxacin Ophthalmic Solution 0.5% (Quantity Level Limit)
  • Lorazepam Concentrate 2mg/ml (Age Limit, 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 1% (Step Therapy Required)
  • Timolol Ophthalmic Gel Solution 0.25%, 0.5% (Quantity Level Limit)
  • Trifluridine Ophthalmic Solution 1% (Quantity Level Limit)


January 2020


  • Buprenorphine-Naloxone Films 2-0.5mg, 4-1mg, 8-2mg, 12-3mg (Quantity Level Limit)


  • Ventolin HFA Inhaler (brand name)


December 2019


  • PreNata Chewable Tab 29-1mg


November 2019

No Updates


October 2019

Other Updates:

  • Cetirizine Solution 1mg/ml (Quantity Level Limit)


September 2019


  • 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)
  • Ramelteon Tab 8mg (Step Therapy Required, Quantity Level Limit)
  • Ribavirin Tab/Cap 200mg (Step Therapy Required)


  • Letairis Tabs 5mg, 10mg (Brand)
  • Rozerem Tab 8mg (Brand)
  • Tracleer Tabs 62.5mg, 125mg (Brand)
  • Uloric Tabs 40mg, 80mg (Brand)


August 2019


  • Aquadeks Drops
  • Butenafine Cream 1% (OTC)
  • Lidocaine Patch 4% (Quantity Level Limit)
  • Thyroid Tabs 180mg, 240mg, 300mg (Quantity Level Limit)


  • Ciclopirox Gel 0.77%
  • Clotrimazole w/ Betamethasone Lotion 1-0.05%
  • Colestipol Granules 5gm
  • Epinastine Ophthalmic Solution 0.05%
  • Fluphenazine Elixir 2.5mg/5ml
  • Fluphenazine Injection 2.5mg/ml
  • Lindane Shampoo 1%
  • Moexipril Tabs 7.5mg, 15mg
  • Nitroglycerin Cap 2.5mg
  • Olopatadine Ophthalmic Solution 0.2%
  • Quinidine Gluconate CR Tab 324mg
  • Thyroid Tab 130mg

Other Updates:

  • Azelastine Ophthalmic Solution 0.05% (Quantity Level Limit)
  • Ciclopirox Cream 0.77% (Step Therapy Required)
  • Ciclopirox Shampoo 1% (Step Therapy Required)
  • Ciclopirox Suspension 0.77% (Step Therapy Required)
  • Fluocinolone Cream 0.025% (Quantity Level Limit)
  • Fluocinolone Ointment 0.025% (Quantity Level Limit)
  • Lidocaine Cream 4% (Quantity Level Limit)
  • Lidocaine Gel 2% (Quantity Level Limit)
  • Lidocaine-Prilocaine Cream 2.5-2.5% (Quantity Level Limit)
  • Liothyronine Tabs 5mcg, 50mcg (Quantity Level Limit)
  • Norethindrone Tab 5mg (Step Therapy Required)
  • Olanzapine ODT Tabs (Age Limit)
  • Olanzapine Tabs (Age Limit)
  • Quetiapine Tabs (Age Limit)
  • Risperidone ODT Tabs (Age Limit)
  • Risperidone Oral Solution 1mg/ml (Age Limit)
  • Risperidone Tabs (Age Limit)
  • Sertraline Concentrate Oral Solution 20mg/ml (Age Limit)
  • Thyroid Tabs 15mg, 30mg, 60mg, 90mg, 120mg (Quantity Level Limit)


July 2019


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


  • Suprax Cap 400mg (brand)
  • Tarceva Tab 150mg (brand)


June 2019


  • Docosanol Cream 10% (Quantity Level Limit)
  • Melatonin Tabs 1mg, 3mg, 5mg


  • Abreva Cream 10% (brand)


May 2019


  • Erythromycin Ethylsuccinate Suspension 400mg/5ml
  • Fulphila Injection 6mg/0.6ml (Prior Authorization Required)
  • Nivestym Injection 300mcg, 480mcg (Prior Authorization Required)
  • Sirolimus Solution 1mg/ml
  • Udenyca Injection 6mg/0.6ml (Prior Authorization Required)


  • Eryped Suspension (brand) 400mg/5ml
  • Rapamune Solution (brand) 1mg/ml



April 2019

Other Updates:

  • Antiretroviral Medications (Diagnosis Confirmation Required)


March 2019


  • Admelog Vial 300 units/3mL
  • Albuterol HFA Inhaler 90mcg – generic Ventolin HFA (Quantity Level Limit)
  • Arthritis Pain Relieving Cream 0.075%
  • Carafate Oral Suspension 1gm/10ml (Age Limit)
  • Mesalamine Suppository 1000mg
  • Toremifene Tab 60mg


  • Canasa Suppository 1000mg
  • Fareston Tab 60mg
  • Norethindrone Acetate & Estradiol-FE Tab 1mg-20mcg (24)

Other Updates:

  • Attention Deficit/Hyperactivity Disorder Stimulant Medications (Age Limit, Removed Prior Authorization)
  • Butalbital Containing Products (Quantity Level Limit)
  • Citalopram Oral Solution 10mg/5ml (Age Limit)
  • Dicyclomine Oral Solution 10mg/ml (Age Limit)
  • Escitalopram Oral Solution 5mg/5ml (Age Limit)
  • Famotidine Oral Suspension 40mg/5ml (Age Limit)
  • Lansoprazole Oral Suspension 3mg/ml (Age Limit)
  • Nitrofurantoin Oral Suspension 25mg/5ml (Age Limit)
  • Nortriptyline Oral Solution 10mg/5ml (Age Limit)
  • Omeprazole Oral Suspension 2mg/ml (Age Limit)
  • Oseltamivir Cap 30mg (Removed Age Limit)
  • Oseltamivir Oral Suspension 6mg/ml (Removed Age Limit)
  • Prednisone Oral Solution 5mg/5ml (Age Limit)


February 2019


  • Arnuity Ellipta Inhaler
  • Eligard Kit 7.5mg, 22.5mg, 30mg, 45mg (Prior Authorization Required)
  • Flebogamma IV Solution 5gm/50ml, 10gm/100ml, 20gm/200ml (Prior Authorization Required)
  • Immune Globulin IV Solution 1gm/10ml, 2.5gm/25ml, 5gm/50ml, 10gm/100ml, 20gm/200ml, 30gm/300ml, 40gm/400ml (Prior Authorization Required)
  • Leuprolide Acetate Kit 1mg/0.2ml (Prior Authorization Required)
  • Ozempic Injection (Quantity Level Limit, Step Therapy Required)
  • Prenatal Vitamin with Ferrous Fumarate-Folic Acid Tab 27-0.8mg (Quantity Level Limit)
  • Prenatal Vitamin with Iron Carbonyl-Folic Acid Tab 29-1mg (Quantity Level Limit)
  • Prenatal Vitamin with Minerals-Ferrous Fumarate-Folic Acid-DHA Pack 28-0.8-200mg (Quantity Level Limit)
  • Prenatal Vitamin without Vit A with Ferrous Fumarate-Folic Acid Chewable Tab 29-1mg (Quantity Level Limit)
  • Prenatal Vitamin without Vit A with Ferrous Fumarate-Iron Polysaccharide Complex-Folic Acid Cap 20-20-1.25mg (Quantity Level Limit)
  • Prenatal Vitamin without Vit A with Ferrous Fumarate-Iron Polysaccharide Complex-Folic Acid Cap 130-92.4-1mg (Quantity Level Limit)
  • Segluromet Tabs (Quantity Level Limit, Step Therapy Required)
  • Steglatro Tabs (Quantity Level Limit, Step Therapy Required)
  • Victoza Injection (Quantity Level Limit, Step Therapy Required)



  • Alprazolam Orally Disintegrating Tabs
  • Cleocin Vaginal Ovule 100mg
  • Clorazepate Dipotassium Tabs
  • Condylox Gel 0.5%
  • Cortifoam Rectal Aerosol
  • Cuprimine Cap 250mg
  • Dihydroergotamine Mesylate Nasal Spray 4mg/ml
  • Dulera Inhaler
  • Elidel Cream 1%
  • Ergotamine SL Tab 2mg
  • Ergotamine-Caffeine Suppository 2-100mg
  • Ergotamine-Caffeine Tab 1-100mg
  • Flovent Diskus
  • Humalog Pens/Cartridges
  • Humalog Vials
  • Invokamet Tabs
  • Invokana Tabs
  • Levonorgestrel-Ethinyl Estradiol Tab 0.15-0.03mg (84) & Ethinyl Estradiol Tab 0.01mg (7)
  • Lidocaine-Hydrocortisone Rectal Kit 20x7gm
  • Lidocaine-Hydrocortisone Rectal Kit 3-1%
  • Meprobamate Tabs
  • Miconazole 3 Suppository 200mg
  • Nitro-Bid Cream Packets 2%
  • Novolog Pens/Cartridges
  • Novolog Vials
  • Plan B Tab (Brand Only)
  • Prenatal Vitamin with Ferrous Fumarate-Folic Acid Tab 65-1mg
  • Prenatal Vitamin with Ferrous Fumarate-L Methylfolate-Folic Acid Tab 27-0.6-0.4mg
  • Prenatal Vitamin with Iron Polysaccharide Complex-Folic Acid Chew Tab 29-1mg
  • Prenatal Vitamin with Iron Polysaccharide Complex-L Methylfolate-Folic Acid Chew Tab 29-0.6-0.4mg
  • Prenatal Vitamin with Minerals with Iron Poly Saccharide Complex-Folic Acid-DHA Cap 29-1-200mg
  • Prenatal Vitamin with Minerals with Iron Poly Saccharide Complex-Folic Acid-DHA Pack 1mg & 250mg
  • Prenatal Vitamin without Vit A with Ferrous Asparto Glyc-L Methylfolate-Folic Acid- DHA Cap 10-0.6-0.4-200mg
  • Prenatal Vitamin without Vit A with Ferrous Asparto Glyc-L Methylfolate-Folic Acid- DHA Cap 18-0.6-0.4-300mg
  • Prenatal Vitamin without Vit A with Ferrous Fumarate-DSS-Folic Acid-DHA Cap 27-1.25-300mg
  • Prenatal Vitamin without Vit A with Ferrous Fumarate-L Methylfolate-Folic Acid-DHA Cap 27-0.6-0.4-300mg
  • Pulmicort Flexhaler
  • Qvar Inhaler
  • Relenza Diskhaler
  • Synjardy Tabs
  • Terconazole Vaginal Suppository 80mg
  • Thalomid Caps
  • Triazolam Caps
  • Trimethobenzamide Cap 300mg
  • Trulicity Injection

Other Updates:

  • Abilify Maintena Injection (Quantity Level Limit)
  • Acyclovir Suspension 200mg/5ml (Age Limit)
  • Alprazolam SR Tabs 0.5mg, 1mg, 2mg, 3mg (Age Limit)
  • Alprazolam Tabs 0.25mg, 0.5mg, 1mg, 2mg (Quantity Level Limit)
  • Aristada Injection (Quantity Level Limit)
  • Breo Ellipta Inhaler (Age Limit)
  • Calcipotriene Cream 0.005% (Quantity Level Limit)
  • Calcipotriene Ointment 0.005% (Quantity Level Limit)
  • Calcipotriene Solution 0.005% (Quantity Level Limit)
  • Chlordiazepoxide Caps 5mg, 10mg, 25mg (Quantity Level Limit)
  • Citalopram Solution 10mg/5ml (Age Limit)
  • Clozapine Tabs (Quantity Level Limit)
  • Dicyclomine Solution 10mg/ml (Age Limit)
  • Escitalopram Solution 5mg/5ml (Age Limit)
  • Famotidine Suspension 40mg/5ml (Age Limit)
  • Flovent HFA Inhaler (Age Limit)
  • Fluphenazine Concentrate 5mg/ml (Quantity Level Limit)
  • Fluphenazine Elixir 2.5mg/5ml (Quantity Level Limit)
  • Fluphenazine Injection 2.5mg/ml (Quantity Level Limit)
  • Fluphenazine Injection 25mg/ml (Quantity Level Limit)
  • Haloperidol Concentrate 2mg/ml (Quantity Level Limit)
  • Haloperidol Decanoate Injection 100mg/ml (Quantity Level Limit)
  • Haloperidol Decanoate Injection 50mg/ml (Quantity Level Limit)
  • Haloperidol Lactate Injection 5mg/ml (Quantity Level Limit)
  • Haloperidol Tabs (Quantity Level Limit)
  • Hydroxyzine Tabs 10mg, 25mg, 50mg (Quantity Level Limit)
  • Invega Sustena Injection (Quantity Level Limit)
  • Invega Trinza Injection (Quantity Level Limit)
  • Jardiance Tabs (Remove Step Therapy, Add Prior Authorization Required)
  • Lansoprazole Suspension 3mg/ml (Age Limit)
  • Lithium Carbonate Caps (Quantity Level Limit)
  • Lithium Carbonate ER Tab 300mg, 450mg (Quantity Level Limit)
  • Lithium Carbonate Tab 300mg (Quantity Level Limit)
  • Lithium Solution 8meq/5ml (Quantity Level Limit)
  • Lorazepam Tabs 0.5mg, 1mg, 2mg (Quantity Level Limit)
  • Loxapine Caps (Quantity Level Limit)
  • Nitrofurantoin Suspension 25mg/5ml (Age Limit)
  • Nortriptyline Solution 10mg/5ml (Age Limit)
  • Olanzapine Orally Disintegrating Tabs (Quantity Level Limit)
  • Olanzapine Tabs (Quantity Level Limit)
  • Omeprazole Suspension 2mg/ml (Age Limit)
  • Oseltamivir Cap 30mg (Quantity Level Limit, Age Limit)
  • Oseltamivir Caps 45mg, 75mg (Quantity Level Limit)
  • Oseltamivir Suspension 6mg/ml (Quantity Level Limit, Age Limit)
  • Oxazepam Caps 10mg, 15mg, 30mg (Quantity Level Limit)
  • Perphenazine Tabs (Quantity Level Limit)
  • Prednisone Solution 5mg/5ml (Age Limit)
  • Prenatal Vitamin with Docusate-Ferrous Fumarate-Folic Acid Tab 29-1mg (Quantity Level Limit)
  • Prenatal Vitamin with Ferrous Fumarate-Folic Acid Chewable Tab 29-1mg (Quantity Level Limit)
  • Prenatal Vitamin with Ferrous Fumarate-Folic Acid Tab 27-1mg (Quantity Level Limit)
  • Prenatal Vitamin with Ferrous Fumarate-Folic Acid Tab 28-1mg (Quantity Level Limit)
  • Prenatal Vitamin with Ferrous Fumarate-Folic Acid Tab 29-1mg (Quantity Level Limit)
  • Prenatal Vitamin with Ferrous Fumarate-Folic Acid Tab 60-1mg (Quantity Level Limit)
  • Prenatal Vitamin with Ferrous Fumarate-Iron Polysaccharide Complex-Folic Acid-Omega 3 Cap 38-1mg (Quantity Level Limit)
  • Prenatal Vitamin without Vit A with Ferrous Fumarate-Folic Acid Cap 106.5-1mg (Quantity Level Limit)
  • Prochlorperazine Suppository 25mg (Quantity Level Limit)
  • Prochlorperazine Tabs (Quantity Level Limit)
  • Quetiapine Tabs (Quantity Level Limit)
  • Risperdal Consta Injection (Quantity Level Limit)
  • Risperidone Orally Disintegrating Tabs (Quantity Level Limit)
  • Risperidone Solution 1mg/ml (Quantity Level Limit)
  • Risperidone Tabs (Quantity Level Limit)
  • Thioridazine Tabs (Quantity Level Limit)
  • Thiothixene Caps (Quantity Level Limit)
  • Trifluoperazine Tabs (Quantity Level Limit)
  • Ziprasidone Caps (Quantity Level Limit)


January 2019

No Changes