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.