Generic medications must meet the same FDA-approved standards as their brand-name counterparts.

They are the same in terms of dosage, safety, strength, quality, how they work and how they should be taken.

 

The Four Tier Pharmacy Plan

There will be a new formulary in 2019. Formulary changes will affect prescription medications covered by the plan. Some members will be impacted by this change, but most will not. The formulary is a list that shows which drugs are covered by your plan and the cost share (pharmacy tier) that applies. For any drugs excluded from coverage, there will be alternative drugs covered by the plan. Aetna will mail letters in late 2018 to those employees taking drugs that will have a change in coverage for 2019.

As part of your Aetna medical plan, your prescription drugs are covered under Aetna’s Standard Plan Formulary. Under this plan, you can fill short-term prescriptions at participating retail pharmacies (up to a 30-day supply) and long-term prescriptions through the mail-order service (up to a 90-day supply) or at a CVS pharmacy.

The Four Tier Pharmacy Plan
Whether you visit a participating retail pharmacy or use the mail-order program, the amount you pay depends on the type of drug used to fill your prescription. Your pharmacy plan has four tiers of benefits.

  • Tier One: You pay the least for generic drugs — a flat fee, or copay, of $10 per prescription.
  • Tier Two: You pay a $35 copay for Tier Two (preferred) brand-name drugs on the Preferred Drug List.
  • Tier Three: You pay 35% of the negotiated price, up to a maximum of $125 at retail pharmacies and $250 using the mail-order service.
  • Tier Four: You pay 40% of the negotiated price. Aetna Specialty Pharmacy® fills prescriptions for specialty drugs.
How much you’ll pay for prescription drugs
  Any network pharmacy for up to a 30-day supply: Maintenance Choice: Aetna Rx Home Delivery or CVS pharmacy for up to a 90-day supply***
Tier One - Generic Drugs $10 copay per prescription $20 copay per prescription
Tier Two - Preferred brand-name drugs $35 copay per prescription $70 copay per prescription
Tier Three – Non-preferred brand-name drugs* 35% of negotiated price**
The minimum you pay per prescription is $60; maximum is $125
35% of negotiated price**
The minimum you pay per prescription is $120; maximum is $250
Tier Four – Specialty Drugs 40% of negotiated price**
The minimum you pay per prescription is $60; maximum is $125
N/A
Fill limit for maintenance medications Coverage for 2 fills only No limit

*Your pharmacy will automatically fill your prescription with a generic drug, if one is available. Learn more about the 'Choose Generics' program.
**Participating pharmacies agree to charge discounted prices for prescriptions filled by Aetna members. Your share of Tier Three and Tier Four drug costs is a percentage of these discounted (or “negotiated”) prices.
***With Maintenance Choice, you can get a 90-day supply of maintenance medications by using either Aetna Rx Home Delivery mail-order pharmacy or a CVS pharmacy near you. After TWO fills at your local retail pharmacy, you will pay the full cost of the drug if you choose to continue to receive a 30-day supply.

Note: 30-day supply prescription fills are only available in the United States, Puerto Rico, Guam and the U.S. Virgin Islands.

Programs and resources to help you save on prescription drugs

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