Save Money on Prescription Needs

Last updated June 27, 2022 at 12:51 PM

Prescription Drug Program


Pharmacy Communications:

Aetna formulary changes effective July 1, 2022. Review changes here. Talk to your health care provider about how these changes might impact you. 

 


For plan year 2022, there are no changes to your prescription drug services with Aetna.

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

  • Terminology

    Terminology used in the Aetna formulary:

    • Generics
    • Preferred Brands
    • Non-Preferred Brands
  • Costs and Eligibility

    Your prescription benefit is dependent on your health plan option. Choose your health plan option below to see a summary of how it works. Please note that the Aetna formulary and summary documents use new terminology:

    Summary of Prescription Drug Benefits located on page 4

                               2022 Health Comparison 

  • Eligibility and Premiums

    The Aetna pharmacy benefit is part of your UVA Health Plan and therefore has the same eligibility requirements as your health plan. Premiums for the UVA Health Plan include prescription drug benefits. See the UVA Health Plan webpage for premiums and eligibility details.

  • 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
  • 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% 
  • Diabetes 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
  • Drugs With No Cost or That Do Not Have a Deductible

    Affordable Care Act

    Contraceptive drugs and over-the-counter preventive items mandated by the Affordable Care Act are covered at no cost to employees. The ACA Preventive Care Drug List shows some items that are available at no member cost share with a prescription (including over-the-counter medications).

    Preventive Medications

    Medications on the Preventive Medication List are applicable to Choice, Value and Basic Health options; drugs on this list are not subject to the deductible, just pay your copay or coinsurance.

    For further information about preventive care, please visit the UVA HR Preventive Care webpage.

  • 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

    30-Day vs. 90-Day Fills: Retail pharmacies can distribute a maximum drug supply of 30 days; however, CVS Pharmacies and UVA Pharmacies 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.
  • 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. 

  • Aetna 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. Click on your health plan option:
    2. Enter the name of the drug.
    3. Click "search" to view the estimate and plan details.
    4. Find Care and Pricing - Sign onto the Aetna member website for access to this tool.

    When using the Digital Care Tool, review the Aetna formulary list, as your drug may be listed as the generic name within the tool.  

    Online Aetna formulary is the most up to date information. 

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 the 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.

Who To Contact For Help

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

  • How do I prepare for out-of-pocket expenses?

    To help UVA employees get the most out of your money for prescriptions, medical, dental, vision, and dependent-care expenses, the University offers benefits-related savings and spending accounts. These accounts allow you to put aside money for eligible expenses, by payroll deduction, before taxes.

    For Basic Health participants, visit the UVA Health Savings Account (HSA) webpage to learn more about how the HSA can be used for prescription and other allowable expenses.

    For information about UVA's medical and dependent daycare flexible spending accounts (FSAs), visit the Flexible Spending Account page.

  • 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. 

  • 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. 

  • 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
  • How 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 use my preferred 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