Aetna Formularies

What Is a Formulary?

A formulary is a list of drugs that insurance companies would like doctors to use when writing prescriptions. The drugs on the formulary are considered the best choices based on safety, effectiveness and reasonable cost. The goal of a formulary is to help control drug costs while offering a wide variety of medication choices. As new drugs become available, the drugs on the formulary may change.

There are two formulary guides, one called Open and one called Closed.

Understanding Open and Closed Formularies

An open formulary means that all of the drugs on the formulary are covered, although the plan pays for a varying share of the costs for generic drugs, preferred brand drugs and non-preferred brand drugs.

Click here to review the 2008 Open Formulary.

A closed formulary requires you to use only those medications that are designated as covered under the unsurer's preferred drug list. If your brand drug is not covered on the closed formulary, you can speak to your doctor about switching to a drug that is on the preferred drug list. Or your doctor may obtain a medical exception from the insurer for the drug to be covered. If you decide to continue taking medications not covered on the closed formulary without obtaining a medical exception, you will pay the full cost; and these expenses do not count toward the plan's deductible or out-of-pocket limits.

Click here to review the 2008 Closed Formulary.

Both open and closed formularies generally have higher cost-sharing for brand drugs than for generic drugs. All formularies are not alike. Each insurer constructs its own Medicare-approved formulary.

Working With Your Doctor on Prescriptions

Because formulary lists vary from plan to plan, your doctor may not know which drugs are on the Aetna formulary. If you receive a prescription, ask your doctor or nurse to check the formulary at http://www.aetna.com/formulary to make sure the drug is listed.

Important to Note

This material is for informational purposed only and is neither an offer of coverage nor medical advice. It contains only a partial, general description of benefits or programs and does not constitute a contract. Aetna Life Insurance Company (Aetna) arranges for the provision of health care services and is not a provider of health care services, and therefore cannot guarantee any results or outcomes.

Many drugs are subject to rebate arrangements between Aetna and the manufacturer of the drugs. Aetna receives rebates from the manufacturers of many drugs. These rebates do not reduce the amount the enrollee pays for an individual prescription drug. However, they help control the overall costs of prescription drug coverage.

These plans contain exclusions and some benefits are subject to limitations. Consult the plan documents to determine governing contractual provisions, including procedures, exclusions and limitations relating to the plan. While this material is believed to be accurate, it is subject to change.