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From: Aetna

To: RxLink®

August 2004

Health Care Professional

The benefit most Aetna members use most frequently is their prescription drug coverage. By dispensing medications on Aetna's Preferred Drug list (also known as a formulary), you can help your patients maximize the value of their pharmacy benefits plan by lowering their costs.

Medications that are not on Aetna's Preferred Drug list generally have a higher copayment under many pharmacy benefit plans and some plans exclude certain non-preferred medications from coverage without a medical exception.

Aetna Preferred Drug List (Formulary)

The Preferred Drug List is a list of FDA-approved, cost-effective drugs that are preferred under many of Aetna's benefit plans. Attached to this letter are lists of drugs that are on the Preferred Drug list in 2005.

Formulary Excluded Drugs

Also attached is a list of Formulary Excluded drugs for 2005. In a closed formulary benefit plan these medications are not covered unless a medical exception is obtained. In open formulary plans these medications may be covered, however non-preferred levels of copay may apply.

Precertification and Step-Therapy Drug Lists

Also attached are lists of drugs that are on Aetna's Precertification and Step-Therapy lists beginning in 2005.


Encourages the appropriate, cost-effective use of some medications by allowing coverage only when certain conditions are met.

Quantity Limits

Are included in our precertification program and are based on generally accepted guidelines and dosing recommendations found on FDA-approved manufacturer labeling.


Means that some drugs are covered by a benefit plan only after one or more prerequisite (clinically appropriate, proven and more cost-effective) drugs are tried first, unless a member's physician obtains a medical exception.

Obtaining Prior Authorization or a Medical Exception

If a member's pharmacy benefit plan includes precertification or step-therapy, the prescribing physician must obtain prior authorization or an exception before these medications will be covered at the member's applicable copay under their plan. If the request is approved, our claims system will be updated to allow coverage of the medication. Physician's are generally notified within 24 hours if the request meets the requirements for coverage under the member's plan.

For easy reference, we have highlighted relevant 2005 Preferred Drug, precertification, and step-therapy information in this mailing, and are providing you with two options to access this information in full.

      At your convenience, you can access the most up-to-date Aetna formulary, precertification, step-therapy and quantity limit information on our Website at

If you have questions about Aetna's Preferred Drug List or pharmacy benefit plans, please contact Aetna's Provider Service Center at 1-800-238-6279.


Eric S. Elliot

President, Aetna Pharmacy Management

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