Prescription Drug Program 2025

• 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 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:
  • UVA Pharmacy:
    • Available to members of all the UVA Health Plan options (Choice, UVA PPO, and Health Savings)
    • UVA Specialty Pharmacy: 434.297.5500
  • CVS Specialty Pharmacy: 800.237.2767
• Retail pharmacies will be able to distribute a maximum drug supply of 30 days, except for CVS Pharmacies and UVA Pharmacy, which can distribute 90-day fills of maintenance drugs.

• 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: Health Savings (Basic), UVA PPO (Value), 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.
  • Please note that the Digital Care Tool provides cost estimates that are based on Aetna's 2022 formulary and pricing.
• 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 UVA PPO and Choice Health participants to pay the reduced 90-day cost-sharing amounts for maintenance drugs while using UVA Pharmacy, 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 Medicine Drugs - If you are enrolled in UVA PPO or Choice Health, check the Chronic 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 Health Savings, 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 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.

Terminology used in the Aetna formulary:

• Generics
• Preferred Brands
• Non-Preferred Brands

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 Pharmacy, 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 Pharmacy 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

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 

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

• Generic Specialty - Deductible +20% ($150 maximum)
• Preferred Specialty - Deductible +20% ($200 maximum)
• Non-Preferred Specialty - Deductible +20% ($350 maximum)

For Health Savings (Basic) 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 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)

COVID-19 Vaccine and Booster

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)

RSV (Respiratory Syncytial Virus) >65 years of age

Shingles (Herpes Zoster)

Tetanus

Td (tetanus and diptheria)

TdaP (tetanus, diptheria, and pertussis)

• Retail pharmacies will be able to distribute a maximum drug supply of 30 days, except for CVS Pharmacies and UVA Pharmacy, 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 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.

• Health Savings (Basic) 
• UVA PPO (Value) 
• Choice Health 

When using the Digital Care Tool, review the Aetna formulary list, as your drug may be listed as the generic name within the tool. Please note that the Digital Care Tool provides cost estimates that are based on Aetna's 2024 formulary and pricing.

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 Pharmacy. 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 offers a $3 discount per prescription on the member cost-share at all UVA pharmacy locations for UVA Health Plan participants. 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. 

Health Savings (Basic) 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. 

UVA PPO (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.

• 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 Pharmacy 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

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. 

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.

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.

• Health Savings (Basic) 
• UVA PPO (Value)  
• Choice Health 

When using the Digital Care Tool, review the Aetna formulary list, as your drug may be listed as the generic name within the tool. Please note that the Digital Care Tool provides cost estimates that are based on Aetna's 2024 formulary and pricing.

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 Pharmacy, 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