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Rx Formulary: 2010 Summary of Changes

Aug 19, 2009


2010 summary of change notices include formulary updates and new safety edits


See 2010 changes to Aetna's Preferred Drug, Precertification. Quantity Limit and Step-Therapy lists.

Each year, Aetna Pharmacy Management (APM) updates its Preferred Drug List. This list shows many of the drugs covered by Aetna pharmacy plans. It’s updated regularly based on the latest medical findings, information from the Food and Drug Administration (FDA), drug makers and cost arrangements, which include manufacturer rebates. Since these updates can greatly affect members and their prescriptions, APM is sending summary of change notices to all members in commercial pharmacy benefits plans. Also in the notices is information about applicable Precertification and Step-Therapy List updates as well as precertification safety edits, kit and Rx/OTC exclusions. All updates take effect January 1, 2010.

To alert members to these changes, the mailing will begin in early September and go through the end of October. As part of APM’s effort to go green, pharmacy members who have reported their e-mail addresses through Aetna Navigator® will get this letter through e-mail instead of through a paper mailing. Members who have not reported their e-mail addresses will receive their letter by third-class mail.

What is changing in 2010?
For 2010, new brand-name and generic drugs are being added to the Preferred Drug List while other brand-name drugs are being removed. This may happen when a brand-name drug’s patent expires during the year. Some drugs are also being added or removed from the Precertification, Quantity Limits and Step-Therapy Lists.

In addition, safety edits will be applied to all commercial PPO plans. This means a limited list of medications requiring precertification and quantity limits will be added to these pharmacy benefits plans. These edits affect drugs that may easily be misused and should only be prescribed for certain conditions. Different safety edits lists will apply to self-funded PPO plans and fully insured PPO plans. These efforts are to protect member safety and encourage appropriate, safe and cost-effective drug therapy.

What are the new exclusions?

Kit exclusions – Medication “kits” will no longer be covered. These kits are made up of prescription drugs packaged with over-the-counter (OTC) supplies. The prescription drug by itself may still be covered, depending on the plan.

Rx/OTC Exclusions – In addition, Aetna will no longer cover prescription medications that have an OTC equivalent. Members may wish to purchase an alternative, over-the-counter product with the same active ingredient(s).

How will members’ out-of-pocket costs change?

Changes to the lists mean that some medications that were once covered will have a higher member responsibility. Members can estimate the cost of their drugs by visiting www.aetna.com and logging into Aetna Navigator. From there, they can click on “Prescription Drugs.” Members may also want to talk to their doctor about alternative treatment options.

To learn more about the Preferred Drug List, or for the most up-to-date preferred drug, precertification, quantity limit or step-therapy information – which is subject to change during the year – go to www.aetna.com/formulary.
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