New Pharmacy Plan as of 1/1/21

Last updated November 12, 2020 at 12:26 PM

New UVA Health Plan Pharmacy Provider


Effective January 1, 2021, UVA’s Health Plan Pharmacy administration will switch from our current provider OptumRx to Aetna, who also administers the UVA Health Plan’s medical program. Combining medical and prescription coverage with a single administrator allows for more aligned and convenient service to meet your health care needs, and delivers financial savings which contributed to no increase in premiums for 2021.

Other advantages to having Aetna as our new pharmacy administrator include:

  • A UVA dedicated concierge service model using Aetna One Advocate. You can connect live to an advocate who is available to​ explain medical care costs​, coordinate care and approvals, connect you with resources, and create a personal care plan​.
  • Access to a Pharmacy Advisor who supports members with chronic conditions.
  • Seamless access to one website with your personal medical and prescription drug information and expenses in a single place. One ID card for both the prescription drug and medical programs. One mobile app to download.
  • Maintenance Choice to offer flexible options for maintenance medications such as reduced cost for 90-day supplies.
  • Several additions to expand your prescription benefits such as insulin pumps, free glucometers, seasonal and preventive vaccine coverage, and more.

Changes to the Prescription Drug Program

Below is information you need to know regarding our new prescription drug program and the changes from OptumRx to Aetna. Please review all of this information now so you have time to ask questions if necessary, and be ready as of January 1 to fill your prescriptions.

  • Overview of new Prescription Benefit by Health Plan Type

    Your new 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:

    • Tier 1 = Generics
    • Tier 2 = Preferred Brands
    • Tier 3 = Non-Preferred Brands

    Basic Health summary of Rx benefits

    Value Health summary of Rx benefits

    Choice Health summary of Rx benefits

  • Changes to Covered Drugs from 2020 Coverage

    • Now included in the Aetna formulary - Prescription vitamins
    • Compounded medications will be limited to $100; claims above the dollar limit threshold will require prior authorization
    • Drugs included on the specialty drug list will change
    • There are two lists of drugs requiring prior authorization or quantity limit, they are:
  • Reduced Cost for Diabetes Drugs

    The new Aetna prescription benefit will reduce 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 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
  • Seasonal and Preventive Vaccines

    Several seasonal and preventive vaccines will be added to the new pharmacy benefit at no cost.

    See the resource “Vaccines Covered by the Aetna Pharmacy Benefit” for a list of the covered vaccines.

     

  • Maintenance Drugs for Chronic Conditions

    Maintenance drugs are prescription drugs you take on a regular basis. All three health plan options will 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 we don't 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

    The Specialty Drug Comparison document compares the drugs on the 2020 OptumRx specialty list with those on the 2020 Aetna Rx specialty list and indicates whether each Optum specialty drug is included on Aetna's specialty list. It also indicates when a drug on the Optum specialty list will no longer be considered a specialty drug in 2021 and when a drug on the Optum specialty list will not be covered under the pharmacy benefit in 2021 but will, instead, be covered as a medical benefit.

    Specialty drugs filled by participants enrolled in Value Health and Choice Health options will be 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)
  • Specialty Medication Pharmacy Locations

    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:

  • Where to fill prescriptions

    NOTE:

    • Retail pharmacies will be able to 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. 

    INSTRUCTIONS FOR SWITCHING PHARMACIES:

    Refills remaining:

    • Contact the new pharmacy where you want your prescription's 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 info (name, street address, telephone number), names of your drugs to transfer, and any other information or directions the new pharmacy requires. 
    • All outstanding refills will follow with transfer.

    No Refills remaining:

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

    Use this convenient tool to find retail pharmacies that are within the Aetna network and 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 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. 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.

  • 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 using the generic name within the tool. The Digital Care Tool are cost estimates and based on Aetna's 2020 formulary and pricing. 

Action Items before January 1

Your prescription drug authorizations that have not expired as of January 1, 2021 will automatically be transferred from OptumRx to Aetna. However, there are actions you may need to take in preparation for the change to Aetna’s pharmacy administrator, and be ready to fill your prescriptions as of January 1.

  • Make sure your pharmacy is in network

    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 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.

  • Determine whether your drugs are included in the Aetna Formulary

    Check the Aetna Standard Plan Formulary to determine whether your current drugs are included on the formulary. 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 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.

  • See where your drugs fall on the Aetna lists and if action needs to be taken

    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 beginning January 1, 2021 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 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.

    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. 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 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 resource and 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.

    5. Preventive Medications - 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.

    6. Specialty & Limited Distribution 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 beginning January 1, 2021. All specialty drugs require prior authorization.

    7. Specialty Drugs Changing Classification - 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 Aetna Information Coming Soon

    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 

Eligibility and Premiums

The Aetna Pharmacy Benefits is part of your UVA Health Plan and therefore has the same eligibility requirements. Premiums for the Health Plan include prescription drug benefits. See the UVA Health Plan webpage for premiums and eligibility details.

Contacts - for Questions and Information

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