|
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.
Precertification
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.
Step-Therapy
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 www.aetna.com/formulary.
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.
Sincerely,
Eric S. Elliot
President,
Aetna Pharmacy Management |
