Part D Prescription Drugs

As a contracted provider in the Aetna Better Health Premier Plan network, you will receive a copy of the List of Drugs/Formulary that we update annually in the provider manual.

For additional information and guidelines about the List of Drugs, please refer to your provider manual. There are also several forms available below to assist you with a variety of needs.

Pharmacy providers may go to CVS/caremark for network and processing information.

Aetna Better Health℠ Premier Plan limits the amount of a drug that we cover. For example, we provide 90 pills in 30 days per prescription for Oxycodone HCL. This may be in addition to a standard one-month or three-month supply. Learn more about Quantity Limit Criteria.

Use the online formulary tool or contact us for the most recent list of drugs at 1-855-767-5772 (TTY: 711), 24 hours a day, seven days a week.

Sometimes we want to first try certain drugs to treat a member's medical condition before we cover another drug for that condition. For example, if Drug A and Drug B both treat the medical condition, we may not cover Drug B unless the member tries Drug A first. If Drug A does not work, then we will cover Drug B. Learn more about step therapy in the list of covered drugs.

View the Step Therapy Criteria.

Use the online formulary tool or call us for the most recent list of drugs at 1-855-676-5772 (TTY: 711), 24 hours a day, seven days a week.

Our formulary is the list of prescription drugs that we cover. We consulted with a team of health care providers to develop the formulary. It includes prescription therapies that we believe to be a necessary part of a quality treatment program.

We generally cover the drugs listed in our formulary as long as the drug is medically necessary. Just remember to send the prescription to a pharmacy in our network. And follow other plan rules.

For a drug that is not on the List of Covered Drugs (formulary), a statement must be provided documenting trial and failure of the formulary medications or a medical reason why the formulary medications cannot be used.

 

Call us toll-free to get the most recent drug list at 1-855-676-5772, 24 hours a day, seven days a week.

 

Aetna Better Health Premier Plan requires you or your physician to get prior authorization for some drugs. This means that you need to get approval from us before you fill your prescriptions. If you don’t, we may not cover the drug. Learn more about Prior Authorization Criteria.

2022 Pharmacy locator tool or the 2023 Pharmacy locator tool

Provider Pharmacy Coverage Determination form

Hospice Part D exception form

Find preferred drugs

We’ve compiled the Aetna Better Health Premier Plan Part B Step Therapy Preferred Drug Lists below for your convenience. Please click below:

Medicare Part B Step Therapy Preferred Drug list 

 

Abraxane® Abraxane (albumin-bound paclitaxel) Medicare (PDF)
Actemra® Actemra (Tocilizumab) Medicare (PDF)
AvsolaTM Avsola (infliximab-axxq) Injectable Medicare (PDF)
Beovu® Beovu (brolucizumab-dbll) Injectable Medicare (PDF)
Botox / Xeomin Botulinum Toxins Medicare (PDF)
 

Cimzia (Certolizumab Pegol) Medicare (PDF)

Entyvio® Entyvio (Vedolizumab) Medicare (PDF)
Epogen/Procrit Erythropoiesis Stimulating Agents (ESAs) Medications/Dialysis Medicare (PDF)
 

ESA Agents Medicare (PDF)

Evenity® Evenity (Romosozumab) Medicare (PDF)
Eylea® Eylea (Aflibercept) Medicare (PDF)
Fulphila® Pegfilgrastim (Fulphila, Neulasta, Nyvepria, Udenyca, and Ziextenzo) Medicare (PDF)
Granix® Filgrastim (Granix, Neupogen, Nivestym, Zarxio) Medicare (PDF)
Herceptin® Herceptin (trastuzumab) Medicare (PDF)
Ilumya™ Ilumya (Tildrakizumab) Medicare (PDF)
Parenteral Immunoglobulins Immune Globulin (IG) Therapy Medicare (PDF)
Inflectra® Inflectra (Infliximab) Medicare (PDF)
Lemtrada® Lemtrada (Alemtuzumab) Medicare (PDF)
 

Leqvio (Inclisiran) Medicare (PDF)

Lucentis® Lucentis (Ranibizumab) Medicare (PDF)
Neulasta® Pegfilgrastim (Fulphila, Neulasta, Nyvepria, Udenyca, and Ziextenzo) Medicare (PDF)
Neupogen® Filgrastim (Granix, Neupogen, Nivestym, Zarxio) Medicare (PDF)
Nivestym™ Filgrastim (Granix, Neupogen, Nivestym, Zarxio) Medicare (PDF)
Nyvepria® Pegfilgrastim (Fulphila, Neulasta, Nyvepria, Udenyca, and Ziextenzo) Medicare (PDF)
Orencia® Orencia (Abatacept) Medicare (PDF)
Prolia®/Xgeva® Prolia, Xgeva (Denosumab) Medicare (PDF)
Remicade® Remicade (Infliximab) Medicare (PDF)
Remodulin Pulmonary Arterial Hypertension (Infusible, Inhalation, or Injectable Medication) Medicare (PDF)
Renflexis® Renflexis (Infliximab-abda) Medicare (PDF)
Rituxan® Rituxan (Rituximab) Medicare (PDF)
Simponi Aria® Simponi Aria (PDF)
Stelara® Stelara (Ustekinumab) Medicare (PDF)
 

Susvimo (Ranibizumab) Medicare (PDF)

 

Tremfya (Guselkumab) Medicare (PDF)

Tysabri® Tysabri (Natalizumab) Medicare (PDF)
UdenycaTM Pegfilgrastim (Fulphila, Neulasta, Nyvepria, Udenyca, and Ziextenzo) Medicare (PDF)
 

Vabysmo (Faricimab-SVOA) Medicare (PDF)

Viscosupplementation Viscosupplementation Medications Medicare (PDF)
Zarxio® Filgrastim (Granix, Neupogen, Nivestym, Zarxio) Medicare (PDF)
Ziextenzo® Pegfilgrastim (Fulphila, Neulasta, Nyvepria, Udenyca, and Ziextenzo) Medicare (PDF)
  Kyprolis (PDF)
  IVIG (PDF)
  Visco (PDF)
  Alpha 1 (PDF)
  Actemra (PDF)
  Darzalex (PDF)
  Darzalex Faspro (PDF)
  Cinqair (PDF)
  Pulmonary Hypertension (PDF)
  Ocrevus (PDF)
  Fasenra (PDF)
  Avastin (PDF)
  Somatuline (PDF)
  Zoladex (PDF)
  Trelstar (PDF)
  Signifor (PDF)
  Lupron (PDF)

 

 

We are committed to making sure our providers receive the best possible information, and the latest technology and tools available.

We have partnered with CoverMyMeds® and SureScripts to provide you a new way to request a pharmacy prior authorization through the implementation of Electronic Prior Authorization (ePA) program.

With Electronic Prior Authorization (ePA), you can look forward to:

  • Time saving
    • Decreasing paperwork, phone calls and faxes for requests for prior authorization
  • Quicker Determinations
    • Reduces average wait times, resolution often within minutes
  • Accommodating & Secure
  • HIPAA compliant via electronically submitted requestsGetting started is easy. Choose ways to enroll:

No cost required! Let us help get you started!

Aetna Better Health of Michigan MMP

  • PCN: MEDDADV
  • Group: RX8827
  • BIN: 610591