Prescription Drug Program

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:
   • Basic Health
   • Value Health
   • Choice Health
2. Enter the name of the drug.
3. Click "search" to view the estimate and plan details.
4. Find Care and Pricing - As of 1/1/21, you can also use the “Find Care and Pricing” tool on Aetna’s website. Sign onto the Aetna member website for access to this tool.

When using the Digital Care Tool, review the Aetna formulary list (the Online Aetna Standard Plan Formulary is the most current; select "Plan Year 2021" and choose "Aetna Standard Plans"). Note that your drug may be listed using the generic name within the tool. The Digital Care Tool offers cost estimates and these costs are based on Aetna's 2020 formulary and pricing. 

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.

The new Aetna prescription benefit reduces the cost-sharing for generic and preferred brand insulin, diabetic drugs, and diabetic supplies for participants. 

• 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 are subject to standard non-preferred cost-share amounts
• Each member with diabetes is eligible for one free glucometer and an upgrade annually
• Insulin pumps are added to the pharmacy benefit; medical coverage does not change

Vaccines

Several seasonal and preventive vaccines have been added to the new pharmacy benefit at no cost. See the Vaccines Covered by the Aetna Pharmacy Benefit List for covered vaccines.

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.

• Prescription vitamins are now included in the Aetna formulary
• Compounded medications are limited to $100; claims above the dollar limit threshold require prior authorization
• Specialty Drugs included on the specialty drug list have changed
• Prior Authorization - There are two lists of drugs requiring prior authorization or quantity limit, they are:
  1. Non-Specialty Drugs Prior Authorization List
  2. Specialty Drugs Prior Authorization List

The new Aetna prescription benefit reduces the cost-sharing for generic and preferred brand insulin, diabetic drugs, and diabetic supplies for participants. 

• 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 are subject to standard non-preferred cost-share amounts
• Each member with diabetes is eligible for one free Glucometer and an upgrade annually
• Insulin pumps have been added to the pharmacy benefit; medical coverage does not change

Several seasonal and preventive vaccines have been added to the new pharmacy benefit at no cost.

See the Vaccines Covered by the Aetna Pharmacy Benefit list for covered vaccines.

Maintenance drugs are prescription drugs you take on a regular basis. All three health plan options have automatically enrolled you in the Aetna Maintenance Choice program if you are currently on 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.

However, you can opt out of the Maintenance Choice program if you do not wish to participate, but be aware that you will not receive the 90-day supply discount rate. 

• Maintenance drugs for chronic conditions may be filled through the Aetna Maintenance Choice program, (with an opt-out option)
• 90-day fills of maintenance drugs may be filled at UVA pharmacies and CVS 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 than UVA or CVS, or you don’t want a 90-day supply of your medication, you can "opt out" of the Maintenance Choice program by calling Aetna Customer Service at 800.987.9072. Opting out allows you to purchase your medications anywhere, and for a 30-day fill period.

• Before you opt out, you can do two 30-day fills of your maintenance drug at retail pharmacies other than UVA or CVS pharmacies, and you will pay regular retail price for the medication (i.e. with UVA covering whatever your health plan option permits)
• After two 30-day refills, you need to decide whether to opt out of the Maintenance Choice Program or participate in it and benefit from the 90-day discount price, using the UVA or CVS pharmacies or CVS mail order pharmacy.
• If you decide to continue with the Maintenance Choice Program:
  • You must fill your maintenance drug prescriptions at UVA or CVS pharmacies, with 90-day supplies
  • You will enjoy the largest discount you can receive on your maintenance medications
  • medication prices at the UVA Pharmacy are often less expensive than those at other pharmacies for UVA employees.
• If you decide to opt out of the Maintenance Choice Program:
  • You can fill your maintenance drug prescriptions at the pharmacy of your choice
  • You will pay the regular retail copay for your 30-day supply (i.e. you will not get the 90-day supply discount, but your health plan is still paying the lion’s share of the drug’s cost)
  • You can choose to opt back in to the Maintenance Choice Program later, if you change your mind
• If you decide to not opt out but still fill a prescription at a pharmacy other than UVA or CVS:
  • You will pay full price for the medication (i.e. without cost-share by your health plan)
• EXAMPLE:
  • With Choice and Value Health, your generic prescription costs $6 for a 30-day supply when you opt out of the Maintenance Choice program. If you do not call to opt out of the Maintenance Choice program, the generic cost could be $100, as you would pay the full cost of the prescription. The prescription will not count towards your coinsurance.
  • With Basic Health, your generic prescription costs a UVA contracted rate of $56 for a 30-day supply when you opt out of the Maintenance Choice program. If you do not call to opt out of the Maintenance Choice program, the generic cost would be $100, as you would pay the full cost of the prescription. The prescription will not count towards your deductible or coinsurance.

Specialty drugs filled by participants enrolled in Value Health and Choice Health options are subject to the deductible.

The cost-share amounts are:

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

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. Be sure to review the updated Aetna Formulary medications list found in 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:

• UVA Pharmacy:
  • Available to members of all the UVA Health Plan options (Choice, Value, and Basic Health)
  • UVA Specialty Pharmacy: 434.297.5500
• CVS Specialty Pharmacy: 800.237.2767

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. 

Refills remaining:

• Contact the new pharmacy where you want your prescriptions transferred and ask if they require any particular steps to accept the transfer. 
• Contact the current pharmacy where your script resides and request the transfer. Provide them with the new pharmacy contact information (name, street address, telephone number), names of your drugs to transfer, and any other information or instructions the new pharmacy requires. 
• All outstanding refills will follow with transfer.

No Refills remaining:

• Ask your doctor/medical provider for a new script.
• Supply your provider with the new pharmacy contact information (name, address, telephone number).

*A script is the order written by your doctor for the prescription.

*Authorization is the health plan's approval of the prescription. 

There are 7 retail UVA pharmacy's and one specialty pharmacy location in this region. See the UVA Pharmacy webpage for locations and addresses (scroll to the bottom of that page). 

Also, use this convenient tool to find all of the retail pharmacies within the Aetna network that are located near you. 

Pharmacy Locator Tool

1. Enter your zip code, or city & state / county & state
2. Choose distance (optional) 
3. Click "Search"

Keep in mind that if you have a maintenance drug with the Maintenance Choice program, you must use CVS or UVA pharmacies for a 90-day supply. You may also opt out of the Maintenance Choice program by calling Aetna; this will enable you to obtain a 30-day supply of your maintenance prescription from any retail pharmacy.

CVS Caremark Mail Service

UVA Aetna members use Aetna member portal to request mail order, please do not use Caremark.com. 

• Request mail order through Aetna.com member portal 
• Phone: 800.987.9072 (Aetna One Advocate Customer Service)

Aetna member portal Mail Order instructions

1. Log onto Aetna.com member portal 
2. Click on Pharmacy within the top bar, this will open Pharmacy page
3. Click New Mail-Order Prescription Request
4. Follow prompts "Select Family Member"; "Drug name"; "Search for Doctor"
5. When completed click Add to Order
6. Remember to Review Order prior to submitting

You may continue to use UVA Pharmacy or CVS to fill your prescriptions under the new Aetna pharmacy administration, and there are other pharmacies within the Aetna network as well.

Check the Aetna National Pharmacy Network and identify whether your current pharmacy is in the Aetna network by using Aetna’s “Find A Pharmacy” tool. Sign onto the Aetna member website for access to this tool.

There are 5 UVA Pharmacies in this region. See the UVA Pharmacy webpage for locations and addresses (scroll to the bottom of that page). 

Also, use this convenient tool to find all of the retail pharmacies within the Aetna network that are located near you. 

Pharmacy Locator Tool

1. Enter your zip code, or city & state / county & state
2. Choose distance (optional) 
3. Click "Search"

Check the Aetna Standard Plan Formulary to determine whether your current drugs are included on the formulary. (Online Aetna Standard Plan Formulary is most current select Plan Year 2021 and Choose Aetna Standard Plans). Also see their tier level, whether they are subject to the deductible, and their cost by using the Digital Care Tool following these directions:

• Click on your health plan option:
  • Basic Health
  • Value Health
  • Choice Health
• Enter the name of the drug.
• Click "search" to view the estimate and plan details.
• As of 1/1/21, you can also use the “Find Care and Pricing” 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.

1. Step Therapy Drugs / Generic before Brand - 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. Check the Step Therapy List to see 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 to bypass the step-therapy precursor medications.

2. Prior Authorization for non-Specialty Drugs - 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 prior authorization list. If they are and you do not have a current prior authorization in place, your provider should request a pre-certification so you can fill your script without interruption.

3. Drugs for Chronic Conditions - 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. With Aetna, you have three options - 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 (other than CVS or UVA), you must call Aetna and opt out of the Maintenance Choice program. Otherwise, your maintenance drugs will not be covered.

4. Preventive and Chronic Medications - If you are enrolled in Value Health or Choice Health, check the Preventive Medicine List and the Chronic Medicine List and identify any of your current maintenance drugs on these lists. Those drugs are not subject to the deductible and are only subject to the standard coinsurance or copay.

5. Preventive Medications - If you are enrolled in Basic Health, check the Preventive Medicine List and identify any of your current maintenance drugs on the list. Those drugs are not subject to the deductible and are subject to the standard coinsurance or copay.

6. Specialty & Limited Distribution 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.

Your new Aetna ID card should have arrived in December. If it did not, you can print it out from the Aetna website after logging in. It has 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 is processed by Aetna. 

Aetna sent 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 has moved 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 have been transferred to Aetna and 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 have transferred to Aetna's mail order service
• Participants currently filling a maintenance medication 

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.

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. 

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 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.

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.

• Basic Health
• Value Health
• 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. The Digital Care Tool are cost estimates and based on Aetna's 2020 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 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

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.