Your Medical Benefit Medication
Aetna Better Health of West Virginia manages drugs given in your doctor’s office, while you are in the hospital or in an infusion center. We do not manage drugs you pick up at a pharmacy. We do not decide what brand of drug you are given. We do not decide what drug you are given based on cost. We do not replace one drug for another. We do not place limits or quotas on drugs. For questions about drugs covered by Aetna Better Health, just call us at 1-888-348-2922.
At least yearly, the Bureau for Medical Services (BMS) decides if any new drugs will be covered or not. You can get to this list by going to https://dhhr.wv.gov/bms/Pages/Chapter-518-Pharmacy-Services.aspx. You can also get details about drugs you pick up at a pharmacy by calling 1-888-483-0797.
Some drugs need to be reviewed by us before they are given. Your doctor can ask for this by calling or faxing our prior authorization team. We will review the request and make a decision based on information from your doctor and criteria. If you are not happy with our decision, you can ask us to look at your request again. This is called an appeal. Your doctor may need to give us more details about why you need the drug. You or your doctor can request an appeal by calling us at 1-888-348-2922.