Maximize Your Benefits

Drugs on the Preferred Drug List may cost you less

Insurance terms can sometimes be confusing. But it's really important for you to understand how your coverage works.

That's why we're taking this opportunity to explain a phrase you'll probably see in your Aetna prescription drug plan: Preferred Drug List. It's also known as a "formulary."

Whatever it's called, you should know that you might be able to save money when the prescription drugs you take are on this list!

How you save 

Aetna prescription drug benefits and insurance plans generally cover the drugs listed on the Preferred Drug List as long as:

• the drug is medically necessary
• plan rules are followed

Not all coverage is the same, however. Depending on your employer, some plans have different copay or coinsurance amounts for brand-name, generic, preferred and non preferred medications.

(You can learn more about costs for generic drugs in our article, Save money with generics.)

Drugs that are preferred are usually covered at a lower copay. That means you pay less out of pocket for those prescriptions.

Safe and effective medicines 

Our Preferred Drug List features medicines approved by the Food and Drug Administration (FDA) as safe and effective. And it includes both brand-name and generic drugs.

Your well-being is an important part of the process. That's why we choose drugs for the Preferred Drug List based on reliable medical information, safety and cost. Many medications, including those on the Preferred Drug List, are subject to manufacturer rebate arrangements* between Aetna and the manufacturer of those medications.

We have a committee that picks the drugs on the list. The committee looks at new drugs and new information about drugs on the market.

They review:

• safety
• effectiveness
• current use in treatment
• scientific evidence from reliable databases — including federal government agencies, pharmaceutical manufacturers, medical professional associations and others

Our committee has licensed pharmacists and doctors, including those who are currently in practice and others who are Aetna employees. All committee members must tell us if they are in a situation that can create a conflict of interest or if they have a financial involvement that might affect their decisions.

The list changes — stay tuned 

We update the Preferred Drug List regularly. Drugs can be added or removed at any time because the FDA approves many new medicines throughout the year. As brand-name drugs lose their patents and generic versions become available, the brand-name may be covered at a higher copay and the generic drug may be covered at a lower copay. That means you might pay less, or you might pay more, for the drug depending on the tier to which the medicine is moved.

Prescription drugs can also be taken off the market or may become available without a prescription. Over-the-counter drugs are not generally covered under a prescription plan.

To get the most current Preferred Drug List information you can use our Medication Search tool.

Coverage for nonpreferred drugs 

If your plan has a "closed formulary" some nonpreferred drugs are not covered. These drugs are called "formulary exclusions."

If your plan has an "open formulary" nonpreferred drugs may be covered, but you may have to pay a higher copay.

There may also be some specific drugs listed on the Preferred Drug List that your plan doesn't cover. Examples of these may include oral contraceptives, diabetic supplies and infertility medications. Refer to your plan documents for further information.

Remember: 

Check your prescription plan documents and any updates we send you during the year. This lets you see what is and isn't covered. Or log on to your secure Aetna Navigator^® member website to review your plan type, copay amounts and other valuable pharmacy plan information.
You and your doctor decide what medicines you need to take. If you're taking a drug that is not covered or nonpreferred, ask your doctor about other drugs that might work just as well.
You should always follow your doctor's advice, even if a prescribed drug is not covered by your plan. Remember — it's your right to ask questions so you understand.

* Rebates that Aetna receives from drug manufacturers do not reduce the amount you pay to the pharmacy for an individual prescription drug. If your copay is a percentage amount, it may be possible in some cases for your cost of a preferred drug to be higher than your cost of a non-preferred drug. Our online cost estimator tools on Aetna Navigator may help you decide which drug will cost you less.