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Pharmacy benefits

At Aetna Better Health® of Louisiana, we cover a wide range of prescription and over-the-counter (OTC) medications to keep members as healthy as they can be.

Contact us

Questions? Just call Provider Relations at 1-855-242-0802 (TTY: 711). 

 

Covered medications

Covered medications

Prescription medications

 

We cover the prescription medications on the preferred drug list (PDL) with small copays (usually $3 or less). If your patient needs medication, you’ll want to check the list for covered medications, step therapy requirements, quantity limits and updates. You can download the list or check it online. 

 

If a medication isn’t listed on the PDL, you can:

 

  •  Prescribe a similar one that’s on the list 
  • Get prior authorization (PA) for coverage

Still not sure if we cover a specific medication? Just call 1-855-242-0802 (TTY: 711). We can check it for you.

Other drug lists

 

You can also see the list of medications we cover for diabetes supplies.

 

Diabetes supplies (PDF)

 

Quantity Limits (PDF)

 

OTC medications

 

Members can get coverage for OTC medications on the PDL (PDF) when they:

 

  • Meet any added requirements (for some medications)
  • Get a prescription from their provider
  • Fill their OTC prescription at a pharmacy in our network

Not sure what’s covered? Just call us at 1-855-242-0802 (TTY: 711). Be sure to have the member’s list of medications ready. We can check to see if they’re on the list.

 

$25 OTC benefit

 

Members can get $25 per month toward some OTC medications and supplies.

 

Learn more about member pharmacy benefits

Specialty medications

Specialty medications

If you prescribe a specialty medication, members can fill it at any pharmacy in our network. Not all pharmacies carry these medications, so members may need to find a specialty pharmacy. Some conditions that need specialty medications include:

 

  •  Cancer
  • Hemophilia
  • Immune deficiency
  • Multiple sclerosis
  • Rheumatoid arthritis

You’ll want to get PA for these medications. Fax the PA form to 1-844-699-2889. Or you can call 1-855-232-3596 (TTY: 711) to ask for PA. You can also include any medical records that may help with the review of your request.

More pharmacy info

Learn about everything from step therapy to prior authorization (PA).

If a member needs prior authorization (PA) for a medication, you can fill out a pharmacy PA form on their behalf. Or you can call us at 1-855-242-0802 (TTY: 711).

 

Visit the Pharmacy PA page

When members need medication, they’ll:

 

  • Ask you to make sure the medication is on the PDL
  • Take their prescription to a pharmacy in our network
  • Show their plan member ID card at the pharmacy

Remind members to check with you at least five days before running out of medication. They understand that you may want to see them before prescribing refills.

Members can fill prescriptions at any pharmacy in our network. We can’t cover medications that they fill at other pharmacies.

 

Find a pharmacy nearby

The step therapy program requires certain first-line drugs, such as generic drugs or brand-name drugs, to be prescribed before approval of specific, second-line drugs. The PDL identifies these drugs as “STEP.”

 

Certain drugs on the PDL have quantity limits. The PDL identifies these drugs with the letters “QLL.” Quantity limits are based on:

 

  •  FDA-approved dosing levels
  • Nationally established, recognized guidelines related to each condition

Need to ask for an override for step therapy or a quantity limit? Just fax the pharmacy PA form to 1-844-699-2889. You can also include any supporting medical records that may help with the review of your request.

 

Learn more about PA

Due to the single PDL implementation in Louisiana, we follow the state P&T decisions. As of February 1, 2021, this committee is no longer active.

 

Here are past agendas for reference:

 

January 26, 2021 (PDF)

 

June 23, 2020 (PDF)

 

December 10, 2019 (PDF)

 

February 11, 2019 (PDF)

 

December 12, 2018 (PDF)

Recalls and resources

 

Also of interest: