Plan for Your Prescription Medication Needs

Prescription Drug Program 2022


Open Enrollment for plan year 2022 is now closed. Please contact the HR Solution Center if you have questions about the Open Enrollment process.


The prescription drug program is part of your UVA Health Plan, and is managed by Aetna. There are no premiums associated with purchasing prescription medications specifically, and the premiums, copays, coinsurance, and deductibles for your health plan option apply to medications.

Key Takeaways

For plan year 2022, there are no changes to your prescription drug services with Aetna. See the schedules of benefits below for details about prescription drug services within your health plan options.

Here are things you should know about the prescription drug program:

  • Terminology

    Terminology used in the Aetna formulary:

    • Generics
    • Preferred Brands
    • Non-Preferred Brands
  • Maintenance Choice Program

    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.

    • 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

    Generic and preferred brand diabetic drugs, insulin, and supplies are 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 is 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

    For Value Health and Choice Health participants only, specialty drug cost-sharing is subject to the deductible. The cost-share amounts will be:

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

    For Basic Health participants, specialty drug cost-sharing is subject to the deductible. The cost-share amount will be:

    • Generic Specialty - Deductible +20%
    • Preferred Specialty - Deductible +20% 
    • Non-Preferred Specialty - Deductible +20% 
  • Seasonal and Preventive Vaccines

    Seasonal and preventive vaccines are part of the pharmacy benefit for those over age 18. Those under age 18 should continue to receive their vaccines through the medical benefit at their doctor's office or at one of the pharmacies in Aetna's Expanded Vaccine Network. The pharmacies should be reminded to bill Aetna instead of AetnaRx so your medical benefit covers the vaccine. 

    The UVA Health Plan with Aetna follows CDC recommendations for vaccines and immunizations.

    Seasonal Flu Vaccines

    Influenza (Flu)

    Non-seasonal Vaccines

    Chicken Pox (Varicella)

    Hepatitis A

    Hepatitis B (Recombinant)

    Hepatitis A and B

    HPV (Human Papillomavirus)

    MMR (Measles, Mumps & Rubella)

    Meningococcal (meningitis)

    Pneumococcal (pneumonia)

    Shingles (Herpes Zoster)

    Tetanus

    Td (tetanus and diptheria)

    TdaP (tetanus, diptheria, and pertussis)

  • 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
    • CVS Specialty Pharmacy or UVA Specialty Pharmacy may fill Limited Distribution Specialty Drugs. 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 2021 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 2021 formulary and pricing. 

    *2022 Aetna formulary changes

  • 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 that if you have a maintenance drug, you can receive a 90-day supply through the maintenance choice program with CVS or UVA pharmacies. You can opt out of the maintenance program by calling Aetna. This will enable you to obtain your maintenance prescription at any retail pharmacy for a 30-day supply. 

  • UVA Pharmacy discount for UVA Health Plan members

    UVA Pharmacies will offer a $3 discount per prescription on the member cost-share at all UVA pharmacy locations for UVA Health Plan participants beginning 1/1/22. UVA Pharmacy has 8 locations throughout central Virginia, including one located at the UVA Health Education Resource Center that is open 24/7 year round. You can also use this discount on the member cost-share for prescriptions delivered directly to your home.

     

    *Discount is automatically applied using your UVA Aetna Health Plan card. 

Action Items

These action items will ensure you’re ready to fill your prescriptions through Aetna:

  • Pharmacy Options

    • Use the “Find A Pharmacy” tool on Aetna’s website to identify if your current pharmacy is in the Aetna network. 
    • Specialty Drugs - 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. 
    • Contacts - 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.
  • Drug Inclusion in Aetna Formulary

    • 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.
    • Sign onto the Aetna member website for access to the “Price A Drug” tool.

     

    • Maintenance Drugs - 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 while using UVA Pharmacies, CVS Pharmacies, and CVS Caremark Mail Service Pharmacy.  If you would prefer to fill a  30-day supply of maintenance drugs through your local retail pharmacy, you must call Aetna and opt out of the Maintenance Choice program. Otherwise, your maintenance drugs will not be covered.
    • Chronic-Preventive Drugs - 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.
    • Preventive Drugs - 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.
    • Specialty Drugs - 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. All specialty drugs require prior authorization.

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 2022 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 2022 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.

    • 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.  

    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 does coverage work for the Generic and Preferred brand diabetic drugs, insulin, and supplies?

    Generic and preferred brand diabetic drugs, insulin, and supplies are 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 2021 formulary and pricing. 

  • Can I 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.

    • 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
This year's Open Enrollment went very smoothly. It was much less stressful than in prior years. LeTrecia Mathis, FPC, Payroll Tax Specialist, University Payroll, Finance

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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."