Formulary

The Aetna Medicare Dual Core formulary documents can be found below.

For a complete description of all member pharmacy benefits click here.

The formulary below lists the drugs covered by Aetna Medicare Dual Core (HMO Plan) Plan. A formulary is just another name for a prescription drug list. We consulted with a team of health care providers to develop this list. It includes prescriptions we believe are needed in a quality treatment program.

We generally cover the drugs in our formulary as long as:

‒        The drug is needed to treat an illness or injury

‒        Your prescription is filled at a pharmacy in our network

‒        You follow any other plan rules that apply

View the 2019 formulary (English|Spanish)

You can get this information for free in other languages. Call 1-800-371-8614 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week. The call is free. And you can contact us for the most recent list of drugs at 1-800-371-8614 (TTY: 711) 8 a.m. to 8 p.m., 7 days a week.

When our formulary is updated we post these changes here.

2019 Formulary Change Form

 

Sometimes you (or your doctor) need to get prior authorization for certain drugs. This means that you need to get approval from the plan before you fill these prescriptions. If you don’t, Aetna Medicare Dual Core (HMO Plan) Plan may not cover the drug.

2019 Prior Authorization Criteria

Sometimes we need you to try certain drugs first to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, Aetna Medicare Dual Core (HMO Plan) Plan may not cover Drug B unless you try Drug A first. If Drug A doesn’t work, Aetna Medicare Dual Core (HMO Plan) Plan then covers Drug B.

2019 Step Therapy Criteria

Find out if your medicine is covered
The formulary lists the drugs covered by Aetna Medicare Dual Core Plan. (A formulary is just another name for a prescription drug list.) We consulted with a team of health care providers to develop this list. It includes prescriptions we believe are needed in a quality treatment program.

Aetna Medicare Dual Core Plan generally covers the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at an Aetna Medicare Dual Core Plan network pharmacy, and other plan rules are followed.