Your formulary will include a table similar to the one below. It’s the key to helping you understand.
The drug(s) covered by your plan
The “tier” level or pricing category – drugs in different tiers may have different costs
Any special rules for a drug that you’ll need to follow, like prior authorization, quantity limit or step therapy
|Drug name||Drug tier||Requirements/limits|
QL (30 EA per 30 days)
You’ll notice drug names are either in italics or CAPITAL letters. These mean:
Italics – generic drugs that generally have lower copays and costs
CAPITALS – brand-name drugs that generally have higher copays and costs
Phrases to know:
MO = mail order
QL = quantity limit
EA = each
There are two ways to find drugs in the formulary:
1. Search by category. For example, omeprazole is listed under “Gastrointestinal agents.”
2. Search by name in the index. The drugs in this section are listed alphabetically.
Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.
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