Aetnamedicaid.net

2014 Changes to Aetna’s Preferred Drug, Precertification, Quantity Limit,
Step Therapy and Aetna Specialty CareRxSM Lists
Medications added to the Preferred Drug List
(* = may be added prior to 1/1/14) AMITIZA VASCEPA*7/1/2013
ZYTIGA*7/1/2013

Medications to be removed from the Preferred Drug List
(^ = generic equivalent available FE = formulary excluded in Closed Formulary Plans NP = non-preferred in Open Formulary Plans)

Medications to be removed from the Formulary Exclusions List
(available in all plans * = may be removed prior to 1/1/14) LATUDA*8/1/2013
VASCEPA*7/1/2013
SAPHRIS*8/1/2013

Medications added to the Precertification List

Medications to be removed from the Precertification List (edit wil no longer apply *=may be removed prior to 1/1/14)
VASCEPA*7/1/2013

Medications added to the Split Fil Program^^^

Medications added to the Quantity Limits or changes to the Quantity Limit

Medications to be removed from the Quantity Limit List (edit wil no longer apply)
UPPER CASE = brand name medication lower case italics = generic medication
Medications added to the Step Therapy List (+ = Trial of a generic equivalent is required first)
RILUTEK+

Medications to be removed from the Step Therapy List
(edit wil no longer apply * = may be removed prior to 1/1/14)
LATUDA*8/1/2013
SAPHRIS*8/1/2013
VASCEPA*7/1/2013
New Benefit Exclusions
None
Additions to Aetna Specialty CareRx List
None
Medications added to the National Precertification List
(* = may be added prior to 1/1/14) HERCEPTIN Medications added to the Safety Edit List

Brand name drugs expected to become available generical y in the near future.
After the generic drug becomes available, the brand name drug may be covered at a higher non-preferred copay and/ or added to
the Formulary Exclusion List. The brand-name drug may also be subject to precertification and/or step therapy. The effective dates of such changes wil be posted on aetna.com. UPPER CASE = brand name medication lower case italics = generic medication
Additional 2014 Changes to Aetna’s Precertification and Step-Therapy Lists effective upon plan
renewal for Louisiana ful y insured commercial members
Drugs requiring precertification
ACTIMMUNE *
Drug(s) requiring step-therapy

* Medication(s) added to the National Precertification List.
# Brand-name drug expected to become available generical y in the near future. After the generic drug becomes available, the
brand name drug may be covered at a higher non-preferred copay/ and or added to the Formulary Exclusion List. The brand-name
drug may also be subject to precertification and/or step therapy. The effective dates of such changes wil be posted on
aetna.com.

UPPER CASE = brand name medication lower case italics = generic medication
Please note that if your prescription drug benefits plan changes, the information in this letter may no longer apply. A copayment is a flat fee. Coinsurance is a percentage of the rate that Aetna negotiates with the plan sponsor for covered prescriptions except as required by law to be otherwise. Some drugs on the Preferred Drug List are subject to manufacturer rebates. Coinsurance is calculated before any rebates are subtracted. That means it may be possible for your cost of a preferred drug to be higher than the cost of a non-preferred drug. Please be aware of how current health care reform guidelines may impact you. Certain religious organizations or religious employers may be exempt from offering contraceptive services, or otherwise qualify for an accommodation from offering such services. Nongrandfathered plans that became effective or renewed after August 1, 2012 and subject to the Affordable Care Act, also known as the health care reform law, must comply with requirements for Women's Preventive Health Services. To learn whether or not these requirements apply to your plan, consult your plan documents for more information. Health benefits and health insurance plans are offered, administered and/or underwritten by Aetna Health Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Florida, by Aetna Health Inc. and/or Aetna Life Insurance Company. In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 06156. Each insurer has sole financial responsibility for its own products. Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC. Aetna Specialty Pharmacy refers to Aetna Specialty Pharmacy, LLC, a subsidiary of Aetna Inc., which is a licensed pharmacy that operates through specialty pharmacy prescription fulfillment. Aetna receives rebates from drug manufacturers that may be taken into account in determining Aetna’s Preferred Drug List. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Information is subject to change. For more information about Aetna plans, refer to www.aetna.com. Please be aware that there are edits to ensure safety and to comply with exclusions of coverage that are required for all commercial books of business in all states. Safety edits are a type of drug coverage review that applies to a limited list of drugs with the highest potential for abuse and harm to the member. Safety edits make sure that the prescribed medicine wil be used within the guidelines set by the Food and Drug Administration and current medical findings. They are part of a commitment to quality pharmaceutical care. Safety edits are required, even when the plan sponsor elects an option to waive precertification. To learn more, please Commercial ful y-insured members in Louisiana and Texas (except Federal Employee Health Benefit Plan members) who have coverage for medications that are added to or removed from the Preferred Drug List, Formulary Exclusion List, Aetna Specialty CareRx List, Split Fill Dispensing Provision, National Precertification List, Precertification Safety Edit List, Precertification List, Step-therapy List or Quantity Limit List, or have Quantity Limits modified, during the plan year wil continue to have those medications covered at the same benefit level under their plan prior to the addition, removal or change, until their plan’s renewal date. The term precertification means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully In accordance with state law, fully-insured Commercial California HMO members (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are added to the Precertification or Step-therapy Lists will continue to have those medications covered, for as long as the treating physician continues prescribing them, provided that the drug is appropriately prescribed and is considered safe and effective for treating the enrollee's medical condition. In accordance with state law, fully-insured Commercial Connecticut PPO members (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are added to the Precertification or Step-therapy Lists will continue to have those medications covered for as long as the treating physician prescribes them, provided the drug is medically necessary and more medically beneficial than other covered drugs. Nothing in this section shal preclude the prescribing provider from prescribing another drug covered by the plan that is medically appropriate for the enrollee, nor shal anything in this section be construed Some programs, such as precertification, quantity limits and step-therapy are not available in all service areas and are subject to change. For example, precertification and step therapy programs do not apply to fully-insured Commercial members in Indiana. Step-therapy does not apply to fully-insured Commercial members in New Jersey. However, these programs are available to self-insured plans and Federal Employee Health Benefit Plans in accordance with plan documents. Please refer to your plan documents or call the Member Services number on your ID card. ^^^Drugs listed are managed by our Aetna Specialty Health Care ManagementSM nurse team. Members receive the support of this team throughout the entire
course of therapy. This team observes a “split fill” dispensing provision. This means that only half of a one month’s supply of medicine is fil ed. Split fil dispensing allows the nurse team to offer more support, including more follow up to monitor response to treatment and potential reactions or side-effects. This helps prevent wasted medicine and saves members money if their medicine or dose changes between refills. This list is not al -inclusive and is subject to change. This material is for information only. It contains only a partial, general description of plan benefits or programs and does not constitute a contract. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Information is subject to change. For more information about Aetna plans, refer to www.aetna.com.

Source: http://aetnamedicaid.net/faqs-health-insurance/documents/2014-summary-changes.pdf