Farmacia

The pharmacy benefit for outpatient prescriptions is carved out to the Bureau for Medical Services (BMS).  Aetna Better Health continues to manage medications delivered in practitioner/provider offices and inpatient facilities. For questions about member benefits related to prescription medications, contact DXC Technology at 1-800-847-3859. For specific prescription medication questions contact Rational Drug Therapy at 1-800-847-3859.

For questions regarding in-office or inpatient medications contact Aetna Better Health at 1-888-348-2922.

The pharmacy benefit for outpatient prescriptions is carved out to Bureau for Medical Services (BMS). Aetna Better Health continues to manage medications delivered in practitioner/provider offices and inpatient facilities.

Annually and after updates, Aetna Better Health communicates to members and prescribing practitioners the following information, as applicable for medical pharmaceutical management:

  • A list of code changes determined by BMS and the Aetna UM Steering Committee (UMSC), including but not limited to
    • Changes to prior authorization requirements that lead to a prior authorization requirement
  • Aetna Better Health does not manage prescriptions, generic substitution, step-therapy, therapeutic interchange
  • Aetna Better Health does not administer a closed formulary for medical pharmaceuticals
  • Aetna Better Health does not use a formulary for management of medical pharmaceuticals
  • For any adverse determination the prescribing provider/practitioner and member can request an exception by utilizing the appeal process as outlined in the Notice of Action
  • Medical pharmacy management follows the same processes as medical requests for services which are outlined in the provider handbook, member handbook, and plan website.

Members and prescribing practitioners are annually notified of medical pharmaceutical procedures and updates by mail, fax, email, or on the Aetna Better Health website.

Members will be notified of any updates of adverse changes via the member newsletter and Aetna Better Health website.  Aetna Better Health mails pharmaceutical management procedures and updates to prescribing practitioners and affected members that do not have email or internet access.

At least annually, medical pharmacy management procedures and medical pharmaceutical codes are reviewed and updated, as appropriate by the UMSC. The UMSC is comprised of senior and plan medical directors representing a broad range of specialties such as emergency medicine, behavioral health, pediatrics, surgery, family medicine and internal medicine and a pharmacist.

If you registered for the provider portal you can check ProPAT. To register for access to the Provider Portal please reach out to your local ABHWV provider relations rep 1-888-348-2922.