2021 List of Covered Drugs/Formulary - Aetna

2021 List of Covered Drugs/Formulary

Aetna Better HealthSM Premier Plan

Aetna Better Health Premier Plan (Medicare-Medicaid Plan) is a health plan that contracts with Medicare and Michigan Medicaid to provide

benefits of both programs to enrollees. For more recent information or other questions, contact us at 18556765772 (TTY: 711), 24 hours a day, 7 days a week or visit

michigan.

29.05.300.1-MI L

Updated on 05/01/2021

H8026_21DRUG LST FINAL APPROVED

Aetna Better Health Premier Plan | 2021 List of Covered Drugs (Formulary)

Introduction

This document is called the List of Covered Drugs (also known as the Drug List). It tells you which prescription drugs and over-the-counter drugs and items are covered by Aetna Better Health Premier Plan. The Drug List also tells you if there are any special rules or restrictions on any drugs covered by Aetna Better Health Premier Plan. Key terms and their definitions appear in the last chapter of the Member Handbook.

Table of Contents

A. Disclaimers.......................................................................................................................................................III B. Frequently Asked Questions (FAQ)...............................................................................................................IV

B1.What prescription drugs are on the List of Covered Drugs? (We call the List of Covered Drugs the "Drug List" for short.).............................................................IV

B2.Does the Drug List ever change?..........................................................................................................IV B3.What happens when there is a change to the Drug List?..................................................................V B4.Are there any restrictions or limits on drug coverage? Or are there any required

actions to take to get certain drugs?...................................................................................................VI B5.How will you know if the drug you want has limits or if there are required actions

to take to get the drug?.........................................................................................................................VI B6.What happens if we change our rules about some drugs (for example, prior

authorization (approval), quantity limits, and/or step therapy restrictions)?.................................VI B7.How can you find a drug on the Drug List?........................................................................................VII B8.What if the drug you want to take is not on the Drug List?.............................................................VII B9.What if you are a new Aetna Better Health Premier Plan member and can't find your

drug on the Drug List or have a problem getting your drug?...................................................................VII B10.C an you ask for an exception to cover your drug?......................................................................... VIII B11.How can you ask for an exception?.....................................................................................................IX B12.How long does it take to get an exception?........................................................................................IX B13.What are generic drugs?.......................................................................................................................IX B14.What are OTC drugs? ............................................................................................................................IX B15.Does Aetna Better Health Premier Plan cover non-drug OTC products?.......................................IX

If you have questions, please call Aetna Better Health Premier Plan at 1-855-676-5772

(TTY: 711), 24 hours a day, 7 days a week. The call is free. For more information, visit

michigan.

I

B16.What is your copay?...............................................................................................................................IX B17.What are drug tiers?...............................................................................................................................X C. Overview of the List of Covered Drugs............................................................................................................XI C1. Drugs Grouped by Medical Condition ....................................................................................................1 D. Index of Covered Drugs.............................................................................................................................. 108

If you have questions, please call Aetna Better Health Premier Plan at 1-855-676-5772

(TTY: 711), 24 hours a day, 7 days a week. The call is free. For more information, visit

II

michigan.

A. Disclaimers

This is a list of drugs that members can get in Aetna Better Health Premier Plan.

Aetna Better Health Premier Plan is a health plan that contracts with both Medicare and Michigan Medicaid to provide benefits of both programs to enrollees.

ATTENTION: If you speak Spanish or Arabic, language assistance services, free of charge, are available to you. Call 1-855-676-5772 (TTY: 711), 24 hours a day, 7 days a week. The call is free.

Si habla espa?ol o ?rabe, tiene a su disposici?n servicios de idiomas gratuitos. Llame al 1-855-676-5772 (TTY: 711), las 24 horas del d?a, los 7 d?as de la semana. Esta llamada es gratuita.

1-855-676-5772 . : . . )711 : (

You can get this document for free in other formats, such as large print, braille, or audio. Call 1-855-676-5772 (TTY: 711), 24 hours a day, 7 days a week. The call is free.

If you wish to make or change a standing request to receive materials in a language other than English or in an alternate format, you can call Member Services at 1-855-676-5772 (TTY: 711), 24 hours a day, 7 days a week.

If you have questions, please call Aetna Better Health Premier Plan at 1-855-676-5772

(TTY: 711), 24 hours a day, 7 days a week. The call is free. For more information, visit

michigan.

III

B. Frequently Asked Questions (FAQ)

Find answers here to questions you have about this List of Covered Drugs. You can read all of the FAQ to learn more, or look for a question and answer.

B1.What prescription drugs are on the List of Covered Drugs? (We call the List of Covered Drugs the "Drug List" for short.)

The drugs on the List of Covered Drugs that starts on page1 are the drugs covered by Aetna Better Health Premier Plan. These drugs are available at pharmacies within our network. A pharmacy is in our network if we have an agreement with them to work with us and provide you services. We refer to these pharmacies as "network pharmacies."

? Aetna Better Health Premier Plan will cover all medically necessary drugs on the Drug List if:

?? your doctor or other prescriber says you need them to get better or stay healthy, and ?? you fill the prescription at a Aetna Better Health Premier Plan network pharmacy.

? Aetna Better Health Premier Plan may have additional steps to access certain drugs (see

question B4 below).

You can also see an up-to-date list of drugs that we cover on our website at michigan or call Member Services toll-free at 1-855-676-5772 (TTY: 711), 24 hours a day, 7 days a week.

B2.Does the Drug List ever change?

Yes, and Aetna Better Health Premier Plan must follow Medicare and Michigan Medicaid rules when making changes. We may add or remove drugs on the Drug List during the year.

We may also change our rules about drugs. For example, we could:

? Decide to require or not require prior approval for a drug. (Prior approval is permission from

Aetna Better Health Premier Plan before you can get a drug.)

? Add or change the amount of a drug you can get (called "quantity limits"). ? Add or change step therapy restrictions on a drug. (Step therapy means you must try one drug

before we will cover another drug.)

For more information on these drug rules, see question B4.

If you are taking a drug that was covered at the beginning of the year, we will generally not remove or change coverage of that drug during the rest of the year unless:

? a new, cheaper drug comes on the market that works as well as a drug on the Drug List now, or ? we learn that a drug is not safe, or ? a drug is removed from the market.

If you have questions, please call Aetna Better Health Premier Plan at 1-855-676-5772

(TTY: 711), 24 hours a day, 7 days a week. The call is free. For more information, visit

IV

michigan.

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download