Getting Your Aetna Prescription - Scripps Research Institute

1 (10/04) Getting To Know your AetnaPrescriptionDrug PlanCovered MedicationsOur Preferred drug List also called a formulary offers you and your doctor achoice of quality, cost-effective, FDA-approvedgeneric and brand-name medications. Thesedrugs were selected with input from a varietyof health care Prescription drug benefits are based on an open formulary. This means thatyour plan covers brand-name and genericmedications on Aetna s Preferred drug List,as well as many others that are not listed. It is also possible that you will have a lowercopayment for drugs on the Preferred DrugList. You can view our most up-to-datePreferred drug List and learn aboutmedication alternatives by If you are already an Aetna member, you can view your plan -specific information on the Aetna Navigator secure memberwebsite at and Step-Therapy*Based on FDA guidelines and currentmedical findings, Precertification and Step-Therapy support member safety andappropriate drug use, and they help keephealth care costs manageable by requiringcertain conditions for coverage.

2 Drugs thatrequire Precertification or Step-Therapy can be found on our website helps encourage safe,cost-effective use of Prescription drugsby requiring prior authorization fromAetna before the drug will be example, certain antibiotics, such as tetracycline, should be carefullyprescribed to children age eight and under. Tetracycline can causediscoloration of children s teeth. Step-TherapyEmployers continue to be challenged byrising drug costs as they strive to providequality, affordable drug benefits to theiremployees. Another way Aetna tries toencourage appropriate, cost-effectivedrug use is through a program Step-Therapy, some drugs arecovered by your benefits plan only afterone or more prerequisites, clinicallyappropriate and cost-effective alternativedrugs, are tried first unless your doctorobtains a medical exception. Thesealternative medications, found on Aetna sStep-Therapy List, are used to treat thesame conditions as the drugs requiringStep-Therapy.

3 *If included in your plan . Precertification and Step-Therapy programs do not apply to membersin Indiana. Step-Therapy is not available in New Jersey. In Texas, precertification approval is known as preservice utilization review and is not verification as defined by Texas with any Prescription drugplan, it s important to learn which drugs are coveredand which coveragerequirements apply. (10/04) Available in Spanish. Disponible en Espa ol. 2004 Aetna Precertificationand Medical ExceptionsIf your medication requires Precertification, your doctor may contact Aetna by phone,fax, or e-mail. In addition, he or she maysubmit a medical exception request forcoverage if you must use a drug on ourStep-Therapy List. If your doctor s request is not approved, you can still get the you will have to pay the full price of the Prescription . Over-the-Counter DrugsMany medical conditions can be treatedsafely with drugs available over the medications have been approved bythe FDA as safe and effective, and theyoften have the same active ingredients as anoriginal Prescription version.

4 Always consultwith your doctor before taking over-the-counter plan does not cover medications thathave over-the-counter equivalents, includingsuch remedies as Claritin and Prilosec 20 mg. Please ask your doctor if an over-the-counter medication is appropriate for you. It may help you save money!Claritin is a registered trademark of Schering-Plough HealthCare Products is a registered trademark of AstraZeneca LLP. Aetna is the brand name used for products and services provided by one or more of the Aetna group ofsubsidiary companies. The Aetna companies that offer, underwrite or administer benefits coverage include: Aetna Health Inc., Aetna Health of California Inc., Aetna Health of the Carolinas Inc., Aetna Health of IllinoisInc., Aetna Health Insurance Company of New York, Corporate Health Insurance Company and/or Aetna LifeInsurance Company. Aetna Pharmacy Management refers to an internal business unit of Aetna HealthManagement, your plan covers outpatient Prescription drugs, your plan may include a drug formulary (Preferred drug List).

5 The Preferred DrugList includes Prescription drugs generally covered under your Prescription drug benefits plan on a preferred basis subject to applicablelimitations and conditions. your pharmacy benefit is generally not limited to the drugs listed on the formulary. The medications listedon the formulary are subject to change in accordance with applicable state law. For information regarding how medications arereviewed and selected for the formulary, formulary information, and information about other pharmacy programs such asPrecertification and Step-Therapy, please refer to Aetna s website at , or the Aetna Medication Formulary drugs, including many of those listed on the formulary, are subject to rebate arrangements between Aetna and themanufacturer of the drugs. Rebates received by Aetna from drug manufacturers are not reflected in the cost paid by a member for a Prescription drug .

6 Inaddition, in circumstances where your Prescription plan utilizes copayments or coinsurance calculated on a percentage basis or adeductible, use of formulary drugs may not necessarily result in lower costs for the member. Members should consult with theirtreating physicians regarding questions about specific medications. Refer to your plan documents or contact Member Services forinformation regarding the terms and limitations of medications, such as oral contraceptives, erectile dysfunction medications, diabetic supplies and infertility medications, mayonly be covered if additional, optional coverage has been added to your standard Prescription drug benefit plan . Please refer to your plan documents for further and Step-Therapy requirements are based on current medical findings, FDA-approved, drug labeling information, andcost and manufacturer rebate arrangements.

7 This material is for informational purposes only and is neither an offer of coverage normedical advice. It contains only a partial, general description of plan benefits or programs and does not constitute a contract. Aetna arranges for the provision of health care services. However, Aetna itself is not a provider of health care services, and therefore,cannot guarantee any results or the plan documents (Schedule of Benefits, Certificate of Coverage, Evidence of Coverage, Group Agreement, GroupInsurance Certificate, Booklet, Booklet-certificate, Group Policy) to determine governing contractual provisions, including procedures,exclusions and limitations relating to the plan . These plans contain exclusions and some benefits are subject to limitations or visit this material is believed to be accurate as of the print date, it is subject to change.

8 Limitations andExclusionsDrugs that are not covered underthe standard Prescription drugbenefit program include but are not limited to:drugs used for thepurpose of weight reduction ( ,appetite suppressants), including thetreatment of obesity over-the-countermedications nutritional supplements smoking cessation aids or drugs growth hormones prophylactic drugsfor travel test agents and devices,excluding diabetic test agents performance, athletic performance, or lifestyle enhancement drugs andsupplies cosmetics or any drugs used for cosmetic purposes or topromote hair growth, including healthand beauty aids replacement for lost or stolen a complete listing of medicationsnot covered by your Prescription drugbenefits program, refer to your plandocuments after Out MoreFor additional information about yourbenefits, claims, the Preferred drug List, Prescription medication cost estimates,and more.

9 Register on the AetnaNavigator secure member website You can also refer toyour summary of benefits or call us atthe toll-free number on your Aetnamember ID card. We ll be happy to help!Log to learn about hundreds ofprescription medications, possible side-effects, potential drug interactions,generic substitutions, tips on how to save money, drug safety, and more.