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A formulary does not cover all prescription drugs. If you do not see your drug on your plan’s formulary, contact the plan to confirm the drug is not covered. If you learn the plan does not cover your drug, you have three options:
Some drugs on the formulary have a utilization management requirement or limitation you need to follow. These are special requirements developed by a team of doctors and pharmacists. Their purpose is to help members use drugs safely and in a cost-effective manner.
The formulary will tell you if your drug has one of these requirements, such as:
Check our formulary page
See if your drug has one of these special requirements.
Requesting an Exception:
You and your doctor can ask us to make an exception to one of your plan’s coverage rules. This includes requesting an exception to a prior authorization, quantity limit or step therapy rule.
Allina Health | Aetna® Medicare has a transition policy for prescription drugs you may be taking that aren't on our formulary or are subject to new utilization management requirements. Under this policy, you can receive a temporary supply of the drug. This policy enables you to work with your doctor to either transition to a new drug or request an exception to continue your current drug.
Click the link below to learn about our transition process to see if you’re eligible for a temporary supply of medication.
Details about our transition process
Federal law prohibits a Part D plan from covering certain types of drugs, including:
ⓘ SilverScript® Plus (PDP) includes coverage for some excluded drugs not typically covered by a Medicare Prescription Drug Plan. These include some prescription vitamins and generic erectile dysfunction drugs.
In addition, Medicare Part D plans are unable to cover the following:
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Allina Health | Aetna is an affiliate of Allina Health and Aetna Life Insurance Company and its affiliates (Aetna). Aetna provides certain management services to Allina Health | Aetna.
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