Plan for Your Prescription Medication Needs

Prescription Drug Program 2021


2020 is a year is like no other. More than ever before, the coronavirus pandemic has heightened concern for health, health expenses, and job security. UVA has been working for over a year on finding additional savings for you with your health benefits.

Changes

Effective January 1, 2021, UVA has successfully renegotiated and updated a contract for medical coverage and prescription drug services with Aetna. 

With Aetna as administrator for both pharmacy (previously held by OptumRx) and health programs, this not only brings savings to you but also additional conveniences:

  • One ID card for both prescription drug program and medical program (a new ID card will be mailed in December)
  • UVA dedicated Aetna One Advocate team with a whole life integration approach and advocacy for you and your family
  • One place to call with questions; one website, one mobile app
  • One personal health record on Aetna's website to find all your medical and prescription drug expenses when evaluating your future health care needs
  • CVS Extracare Health cards will be issued to all subscribers 
    • Use your CVS Extracare Health card to receive 20% discount off CVS Health brands every day
  • Listen to this new podcast about the Aetna One Advocate service model and other Aetna changes
  • Prior authorizations that have not expired are being transferred from Optum to Aetna

Basic Health summary of Rx benefits

Value Health summary of Rx benefits

Choice Health summary of Rx benefits

Changes to the prescription drug program for 2021 are detailed below:

  • New Terminology

    New terminology will be used in the Aetna formulary 

    • Tier 1 = Generics
    • Tier 2 = Preferred Brands
    • Tier 3 = Non-Preferred Brands
  • Changes to Covered Drugs

    • Included in the Formulary:
      • Prescription vitamins
    • Drugs included on the specialty drug list will change
    • Traditional drugs requiring prior authorization or quantity limit will change
    • Compound medications will be limited to $100; claims above the dollar limit threshold will require prior authorization
  • Maintenance Drugs for chronic conditions- Where to get them filled?

    Maintenance drugs are prescription drugs you take on a regular basis. All three health plan options automatically enroll you in the Aetna Maintenance Choice program with Opt-Out for maintenance drugs. The Maintenance Choice program offers you 90-day supplies of maintenance drugs at a discounted rate equal to mail order rates through the CVS Caremark Mail Service Pharmacy. You can purchase your maintenance drugs at local CVS pharmacies, UVA pharmacies, or by mail through the CVS Caremark Mail Service Pharmacy.

    • Maintenance drugs for chronic conditions will be filled through the Aetna Maintenance Choice program with Opt-Out 
    • 90-day fills of maintenance drugs may be filled at CVS pharmacies and UVA pharmacies and receive the same discounted rate charged when filled at the CVS Caremark Mail Service Pharmacy

    If you prefer to purchase your prescription drugs through a different pharmacy, you can "opt out" of the Maintenance Choice program by calling Aetna Customer Service at 800.987.9072 after January 1, 2021.

    • Once you opt out of the Maintenance Choice program, you'll pay the regular retail copay for your 30-day supply. 

    If Aetna does not hear from you

    • 30-day fills of maintenance drugs can only be filled twice at other retail pharmacies unless you opt out of Maintenance Choice Program 
    • After two fills, you may pay full price for the medication
  • Diabetic Drugs, Insulin, Supplies and Free Glucometer

    Because it's important for you to take your diabetic medicine to reach your best health. Effective January 1, 2021 a new program will reduce the cost-sharing for generic and preferred brand insulin, diabetic drugs and diabetic supplies for participants. The plan will pick up much of the costs. 

    • Generic and preferred brand diabetic drugs, insulin, and supplies will be subject to the following special cost-share amounts for all health plan options: 
      • 30-day supply generic - $0
      • 30-day supply preferred brand - $34
      • 90-day supply generic through Maintenance Choice - $0
      • 90-day supply preferred brand through Maintenance Choice - $75
      • All non-preferred brand diabetic drugs, insulin, and supplies will be subject to standard non-preferred cost-share amounts
    • Each member with diabetes will be eligible for one free Glucometer and an upgrade annually
    • Insulin pumps will be added to the pharmacy benefit; medical coverage will not change

    UVA Health Plan Schedule of Benefits Comparison 

  • Specialty Medications

    Aetna Specialty Drug List differs from OptumRx Specialty Drug List. Please review the 2020 OptumRx Specialty Drug List- Comparison to 2020 Aetna Rx Specialty Drug List.

    Specialty Drug Comparison list- This document compares the drugs on OptumRx Specialty July 2020 list with those on the Aetna Rx Specialty July 2020 list. This list contains all specialty drugs that were on the OptumRx Specialty list and indicates whether each drug is included on or excluded from Aetna's specialty list. It also indicates whether the drug is no longer a specialty and whether it is covered as a medical benefit. 

    Rx benefit changes for Value Health and Choice Health options only

    Specialty drug costsharing will be subject to the deductible. 

    The costshare amounts will be:

    • Generic Specialty- Deductible +20% ($100 maximum)
    • Preferred Specialty- Deductible +20% ($150 maximum)
    • Non-Preferred Specialty- Deductible +20% ($200 maximum)

     

  • Seasonal and Preventive Vaccines

    Seasonal and preventive vaccines will be added to the pharmacy benefit; medical coverage will not change.

  • Where to Fill Your Prescriptions

    • Retail pharmacies will be able to distribute a maximum drug supply of 30 days, except for CVS Pharmacies and UVA Pharmacies, which can distribute 90-day fills of maintenance drugs
    • Limited Distribution Specialty Drugs may be filled through the CVS Specialty Pharmacy or UVA Specialty Pharmacy. All other specialty drugs must be filled through the UVA Specialty Pharmacy. 

    Switching to UVA or CVS pharmacy locations

    Refills remaining:

    • Ask the pharmacy to which you want to move the prescription  to help transfer the script.
    • Tell the pharmacy where the script is currently being processed. Provide name, street address of pharmacy and specific name of drug(s) for transfer.
    • All outstanding refills will follow with transfer.

    No Refills remaining:

    • Ask your provider for a new script.
    • Provide the name and address of the new pharmacy you wish to send the script to your provider.
  • Aetna's Digital Care Tool - Drug Cost Estimates

    Aetna's Digital Care Tool provides drug cost estimates based on the selected UVA Health Plan option. Use the links below to compare prices between the UVA Health Plan options.

    1. Enter the name of the drug,
    2. Click "search" to view the estimate and plan details.

    When using the Digital Care Tool, review the Aetna formulary list, as your drug may be listed as the generic name within the tool. The Digital Care Tool are cost estimates and based on Aetna's 2020 formulary and pricing. 

  • Pharmacy Locator Tool

    Use this tool to find retail pharmacies within your plan that are near your location. Simply enter your ZIP code, city and state, or county and state.

    Pharmacy Locator Tool 

    1. Enter your Zip, or City & State or county and state
    2. Choose Distance (optional) 
    3. Click "Search"

    This tool provides network pharmacies. Keep in mind if you have a maintenance drug. With the maintenance choice program you will need to use CVS or UVA pharmacies for a 90 day supply. Or Opt-out of the maintenance program by calling Aetna, after January 1, 2021. To obtain your maintenance prescription any a retail pharmacy for a 30 day supply. 

    **Aetna is aware of a glitch within the Pharmacy Locator** The system will show the 90 day supply symbol on other retail pharmacy locations. CVS and UVA pharmacies are the only locations able to provide 90 day supply for maintenance medication.  

Action Items

These action items will ensure you’re ready to fill your prescriptions through Aetna on January 1, 2021 

  • Check the Aetna National Pharmacy Network and identify whether your current pharmacy is in the Aetna network.  Use Aetna’s Pharmacy Locator tool. Choose "Aetna National Pharmacy Network” as your Plan. As of January 1, 2021, use the “Find A Pharmacy” tool on Aetna’s website. Sign onto the Aetna member website for access to this tool.
  • Check the Aetna Standard Plan Formulary and determine whether your current drugs are included on the formulary. Also determine their tier, whether they are subject to the deductible, and their cost by using the Digital Care Tool during open enrollment:
    • Click on the appropriate link depending on which health plan option you are enrolled in: Basic Health, Value Health, or Choice Health.
    • Enter the name of the drug and click on "search" to view the estimate and plan details.
    • As of January 1, 2021, use the “Price A Drug” tool on Aetna’s website. Sign onto the Aetna member website for access to this tool.
  • Check the Formulary Exclusions resource for drugs not covered on the Aetna Standard Plan Formulary and their covered alternatives. If your drug is excluded and you have a unique medical situation that requires you keep taking it, your provider can submit a request for a medical exception beginning on January 1, 2021.
  • Check the Step Therapy List resource for a list of drugs requiring step therapy and determine if your current brand drugs require the use of generic medications before they will be covered. If your drug is on the list and you previously tried the generic medications and found them to be ineffective, your provider can request a pre-certification from Aetna beginning January 1, 2021 to bypass the step-therapy precursor medications.
  • Check the Prior Authorization List (Non-Specialty Drugs) resource for a list of non-specialty drugs requiring prior authorization and determine if your current drugs are on the PA list. If they are and you do not have a current prior authorization in place with OptumRx that will be unexpired for your first fill in 2021, your provider should request a pre-certification beginning January 1, 2021 so you can fill your script without interruption.
  • If you are currently taking any maintenance drugs for chronic conditions, read the Maintenance Choice with Opt-Out Flyer resource. The Maintenance Choice program expands the options for Value Health and Choice Health participants to pay the reduced 90-day cost-sharing amounts for maintenance drugs. Currently, your only option for the reduced cost is to use OptumRx’s Mail Service option. With Aetna, you will have three options - UVA Pharmacies, CVS Pharmacies, and CVS Caremark Mail Service Pharmacy.  Other retail pharmacies will not be able to fill 90-day supplies of maintenance drugs after December 31, 2020. If you would prefer to fill a  30-day supply of maintenance drugs through your local retail pharmacy (other than CVS or UVA), you must call Aetna, after January 1, 2021 and opt out of the Maintenance Choice program. Otherwise, your maintenance drugs will not be covered.
  • If you are enrolled in Value Health or Choice Health, check the Chronic-Preventive Medicine List resource and identify any of your current maintenance drugs on these lists. Those drugs will not be subject to the deductible and will only be subject to the standard coinsurance or copay.
  • If you are enrolled in Basic Health, check the Preventive Medicine List resource and identify any of your current maintenance drugs on the list. Those drugs will not be subject to the deductible and will only be subject to the standard coinsurance or copay.
  • Check the Specialty Drug List resource for a list of specialty drugs. If any of your current drugs are on this specialty list, they must be filled through the UVA Specialty Pharmacy to be covered. If they are Limited Distribution Drugs, they can also be filled through the CVS Specialty Pharmacy beginning January 1, 2021. All specialty drugs require prior authorization.
  • If you are currently on a specialty drug, check the Specialty Drug Comparison list resource which compares the current OptumRx Specialty Drug List with Aetna’s 2020 Specialty Drug List. It indicates whether each drug is included on or excluded from Aetna’s specialty list. It also indicates whether the drug is no longer a specialty drug and whether it is covered as a medical benefit. If a current specialty drug is a non-specialty drug with Aetna, you will no longer need to fill it through the UVA Specialty Pharmacy. If it is covered as a medical benefit, you should obtain it at your provider’s office.
  • Watch for your new Aetna ID card to arrive in December. It will have an RX BIN# on the front of the card. Present this new card to your pharmacist when you fill a prescription in 2021 so your script will be processed by Aetna. 
  • Aetna will send letters to UVA Health Plan participants in December 2020 with additional information if they fall into any of the following scenarios:
    • Participants currently using an out-of-network pharmacy
    • Participants currently filling a medication that is excluded from the formulary
    • Participants currently filling a medication that is excluded from the Plan
    • Participants currently filling a medication in tier 2 that will move to tier 3 with Aetna
    • Participants currently filling a medication that requires step therapy
    • Participants currently filling a non-specialty medication that requires a prior authorization; all prior authorizations in place with OptumRx will be transferred to Aetna and will retain their OptumRx expiration date
    • Participants currently filling a specialty medication
    • Participants who qualify for no-cost glucose meter
    • Participants currently filling a preventive medication
    • Participants currently filling a medication using OptumRx's mail order service; existing refills for all medications except compounds and controlled substances will transfer to Aetna's mail order service
    • Participants currently filling a maintenance medication 

Pharmacy Options

When you have specialty pharmacy needs, the UVA Specialty Pharmacy is available to assist you by filling prescriptions for complex medical conditions that require special storage, handling and delivery that most retail pharmacies aren't equipped to handle. Remember that medication prices at the UVA Pharmacy are often less expensive than those at other pharmacies for UVA employees. Be sure to review the updated Aetna Formulary medications list, found on the list of Resources below.

Limited Distribution Specialty Drugs may be filled through the CVS Specialty Pharmacy or UVA Specialty Pharmacy. All other specialty drugs must be filled through the UVA Specialty Pharmacy. 

You can use the numbers below to contact the UVA Pharmacy and CVS Specialty Pharmacy for your specialty pharmacy needs:

Retail pharmacies will be able to distribute a maximum drug supply of 30 days, except for CVS Pharmacies and UVA Pharmacies, which can distribute 90-day fills of maintenance drugs.

Eligibility

The Aetna pharmacy program is part of your UVA Health Plan, and therefore has the same eligibility requirements as for the Health Plan. See the Health Plan 2021 webpage for additional eligibility details.

Premiums

The Aetna pharmacy program is part of your UVA Health Plan, and therefore premiums for the Health Plan include prescription drug benefits. See the Health Plan 2021 webpage for premium details.

Enroll in Workday

  • To review and elect your benefits in Workday

    Please see the video below on the new Benefits Tiles system in Workday, which will apply both for Open Enrollment and for all benefits changes throughout the year. 

    A summary of how to review and elect your benefits in Workday is below:

    • Navigate to Workday.
    • In your Workday Inbox, click on the message titled "Open Enrollment Change: [Your Name] on 01/01/2022"; click on "Let's Get Started."
    • Open Enrollment in Workday this year is organized into "tiles" for each benefit; you will see two sections, one for Health Care and Accounts, and one for Insurance. Each section has multiple tiles. You will start with Health Care and Accounts.
    • You will have three edit options at the bottom of every tile:
      • Manage to make changes to a benefit you already have
      • Enroll to add a new benefit
      • View to see a benefit that is not editable in Workday (more on this further down)
    • Select a tile and choose the edit option for that tile.
    • Once you've selected or waived a benefit in the Health Care and Accounts section, click on Confirm and Continue -- this will take you to a separate window to select or waive eligible dependents for that benefit. Dependents previously enrolled who are eligible will show up automatically, you just need to select or waive each one of them.
    • Click Save to update the benefit tile. This does NOT submit your elections, it just saves the individual benefit tile details you've selected. 
    • Repeat the above process for all six Health Care and Accounts tiles.
    • One thing Workday doesn’t do in the new tile platform is give you a status update on which benefits you’ve touched. So, it would be a good idea to make a note as you complete them so you can track your progress.
    • Once you've completed the Health Care and Accounts section, move on to the Insurance section. You will see multiple tiles under Insurance.
    • Select a tile and choose the edit option for that tile.
    • Please note that some life insurance benefits are VIEWABLE in Workday but not changeable. Each of these tiles will direct you to where you need to go to make changes. Some of these changes may be outside of Workday.​
    • Once all your benefits have been reviewed and edited as needed, click on Review and Sign -- read the summary of what's you elected on that page, and attach any required documents such as birth certificate for new dependents.
    • Click on the I Accept box, then click on Submit to complete your Open Enrollment process.
    • Print this page or save it as a PDF.
    • Look for additional tasks in Workday for things such as spousal affidavits or HSA affidavits.​
  • If you Change Your Mind on an Open Enrollment Choice You Made and Open Enrollment Has Not Closed

    You can make changes to your elections as long as the Open Enrollment period is open, even after you have submitted your elections.

    1. From the Benefits app in Workday, click on Change Open Enrollment
    2. You will be making changes to what has been previously submitted. Any changes made will need to be resubmitted. If you do not resubmit, the changes will be deleted and the previous submission will remain in effect.
    3. Move through the same tiles to elect or waive coverage.
    4. Once changes are complete, electronically sign at the bottom of the last page and press the Submit button.
    5. Print the new confirmation of benefits elections.

Contacts

Aetna Member Services Department

  • Phone: 800.987.9072
  • Hours of Operation:
  • Monday through Friday: 8 am - 8 pm (for any time zone)
  • Saturday: 8 am - 4:30 pm, EST
  • Claims Mailing Address: P.O. Box 981106, El Paso, TX 79998-1106

Aetna Medical/Pharmacy Pre-certification Department

CVS Specialty Pharmacy

UVA Specialty Pharmacy

Resources

FAQs - Prescription Drug Program

  • How do my deductible, coinsurance, and min/max drug tiers work with prescription drugs?

    Basic Health participants have a deductible that applies to both medical and prescription costs. You must pay for covered health care services and prescriptions up to your deductible amount before the UVA Health Plan begins to pay. 

    Value and Choice Health participants have a deductible that applies to both medical and prescription costs for preferred brand and non-preferred brand retail drugs. You must pay for covered prescriptions up to your deductible amount before the UVA Health Plan begins to pay for preferred brand and non-preferred brand retail prescriptions and specialty prescriptions. Generic medications are not subject to the deductible. 

    The table below shows costs for retail pharmacy outside of UVA and CVS pharmacies (such as Target, Walgreens, Kroger, etc.); excludes specialty prescriptions and mail order prescriptions.

    Drug Tier Choice Value Basic

    Generic, low cost

    $6 co-pay

    30-day supply

    $6 co-pay

    30-day supply

    Deductible + 20% for up to 30-day supply

     

    Preferred Brand

    Deductible + 20%

    $34 min/$150 max

    30-day supply

    Deductible + 20%

    $34 min/$150 max

    30-day supply

    Deductible + 20% for up to 30-day supply

     

    Non-Preferred Brand

    Deductible + 20%

    $68 min/$225 max

    30-day supply

    Deductible + 20%

    $68 min/$225 max

    30-day supply

    Deductible + 20% for up to 30-day supply
           
    • Maintenance drugs for chronic conditions will be filled through the Aetna Maintenance Choice program with Opt-Out 
    • 90-day fills of maintenance drugs may be filled at CVS pharmacies and UVA pharmacies and receive the same discounted rate charged when filled at the CVS Caremark Mail Service Pharmacy

    If you prefer to purchase your prescription drugs through a different pharmacy, you can "opt out" of the Maintenance Choice program by calling Aetna Customer Service at 800.987.9072 after January 1, 2021.

    • 30-day fills of maintenance drugs can only be filled twice at other retail pharmacies unless you opt out of Maintenance Choice
    • After two fills, you may pay full price for the medication
  • Which medications require prior authorization? And what is the process?

    Aetna Standard Formulary Prior Authorization List (Non-Specialty Drugs) is a list of medications that require a prior authorization. Prior authorization means that you must obtain approval for certain medications before you are able to get them. Getting your prior authorization, if required, will save you time at the pharmacy. 

     

    Process for submitting Prior Authorization 

    Your provider can submit a prior authorization request to Aetna. The Prior Authorization form can be used for prior authorization and for medical necessity exceptions. Requests can be sent through phone, fax or online. 

  • What is the Step Therapy Program and how does it work?

    The medications on the step therapy list require the use of generics first before the use of brand medication. You may need to try out options in steps, starting with their least expensive versions. If you have a medical need for one of the brand medications, your doctor can ask for an exception. 

  • What are the changes for Generic and Preferred brand diabetic drugs, insulin, and supplies?

    Generic and preferred brand diabetic drugs, insulin, and supplies will be subject to the following special cost-share amounts for all health plan options: 

    • 30-day supply generic - $0
    • 30-day supply preferred brand - $34
    • 90-day supply generic through Maintenance Choice - $0
    • 90-day supply preferred brand through Maintenance Choice - $75
    • All non-preferred brand diabetic drugs, insulin, and supplies will be subject to standard non-preferred cost-share amounts

    Each member with diabetes will be eligible for one free Glucometer and one upgrade annually.

  • Can I get a cost estimate for my prescription?

    Aetna's Digital Care Tool- provides drug cost estimates based on the selected UVA Health Plan option. Use the links below to compare prices between the UVA Health Plan options.

    1. Enter the name of the drug,
    2. Click "search" to view the estimate and plan details.

    When using the Digital Care Tool, review the Aetna formulary list, as your drug may be listed as the generic name within the tool. The Digital Care Tool are cost estimates and based on Aetna's 2020 formulary and pricing. 

  • Will I need a new drug authorization when switching from Optum to Aetna?

    Prior authorizations that have not expired are being transferred from Optum to Aetna. 

    Aetna will send letters to UVA Health Plan participants in December 2020 with additional information if they fall into any of the following scenarios:

    • Participants currently using an out-of-network pharmacy
    • Participants currently filling a medication that is excluded from the formulary
    • Participants currently filling a medication that is excluded from the Plan
    • Participants currently filling a medication in tier 2 that will move to tier 3 with Aetna
    • Participants currently filling a medication that requires step therapy
    • Participants currently filling a non-specialty medication that requires a prior authorization; all prior authorizations in place with OptumRx will be transferred to Aetna and will retain their OptumRx expiration date
    • Participants currently filling a specialty medication
  • Can I still use my local pharmacy when purchasing Maintenance Medication?

    Maintenance drugs are prescription drugs you take on a regular basis. All three health plan options automatically enroll you in the Aetna Maintenance Choice program with Opt-Out for maintenance drugs. The Maintenance Choice program offers you 90-day supplies of maintenance drugs at a discounted rate equal to mail order rates through the CVS Caremark Mail Service Pharmacy. You can purchase your maintenance drugs at local CVS pharmacies, UVA pharmacies, or by mail through the CVS Caremark Mail Service Pharmacy.

    If you prefer to purchase your prescription drugs through a different pharmacy, you can "opt out" of the Maintenance Choice program by calling Aetna Customer Service at 800.987.9072 after January 1, 2021.

    • Once you opt out of the Maintenance Choice program, you'll pay the regular retail copay for your 30-day supply. 

    If Aetna does not hear from you

    • 30-day fills of maintenance drugs can only be filled twice at other retail pharmacies unless you opt out of Maintenance Choice Program 
    • After two fills, you may pay full price for the medication
  • Why is my medication no longer considered preventive with Aetna?

    Each pharmacy administrator creates its own process for determining how drugs are categorized and covered. As a pharmacy administrator, Aetna created a list of preventive medications that includes drugs generally prescribed for individuals who may be at risk for certain diseases or conditions but who are not  showing signs of that disease or condition. Drugs on the list are used to prevent a disease or condition, complications from a disease, or the reoccurrence of a condition. Drugs on the preventive medication list help promote medication adherence. Aetna’s preventive medication list is also compliant with IRS guidance in notices from 2004 through 2019 which detail conditions and their preventive care treatment that’s allowed to be covered by a high deductible health plan before the deductible is met.

I used multiple resources to assess my situation and determine which benefits were best for me. The website was especially outstanding! I feel like you guys really nailed it with the information there. I did not feel like I was inundated unnecessarily with messages but I definitely understood the importance and limited timeframe. I also especially appreciated how clearly all of the changes were communicated including that there would be no grace period this year for folks who missed the deadline. Kirsten Gibson, Project Coordinator, Professional Nursing Staff Organization Support Office

Having trouble finding what you’re looking for?

We strive to make the information on every webpage clear and easy to find. Please let the HR Communications team know if you're having trouble finding what you're looking for, so we can improve your experience on this page in the future. 

For non-website questions or concerns about benefits and Open Enrollment, please contact the HR Solution Center by phone at 434.243.3344, or by email at AskHR@virginia.edu.

For previous Open Enrollment email communications, see the right sidebar box on this page labeled "Open Enrollment Emails."