2025 Formulary Exclusions Drug List PREFERRED OPTIONS LIST FOR FORMULARY DRUG REMOVALS AND DRUGS COVERED ONLY WHEN PREFERRED OPTIONS ARE NOT …
January 2025 The 2025 Aetna Standard Plan Pharmacy Drug Guide is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered the …
How to use this guide You may fill these drugs at an in-network specialty pharmacy. Look up your plan documents for specialty drug coverage details. You’ll also learn more about the requirements and …
Introduction This document is called the List of Covered Drugs (also known as the Drug List). It tells you which drugs and over-the-counter (OTC) drugs and non-drug products and items are covered by …
Is this request urgent? Defined as: A delay of service could seriously jeopardize the life or health of the member or the ability of the member to regain maximum function. – Or – In the opinion of a physician …
Aetna Vision Preferred DirectTM individual plans Policies and plans are insured and/or administered by Aetna Life Insurance Company (Aetna). Certain claims administration services are provided by First …
The number of doses available under the dose restriction for the prescription drug, based on both sound clinical evidence and medical and scientific evidence, the known relevant physical or mental …
Your Member Handbook This is your member handbook. This is a guide to help you understand your health plan and benefits. Throughout the handbook, we will refer to “the Plan.” When we do, we are …
The State Health Plan transitioned its third-party administrator for its commercial plans from Blue Cross NC to Aetna® beginning January 1, 2025.
Some covered services have limitations, based on your age or how often you use them. Members can start using their benefits right away for preventive care services. There’s no waiting period for basic …