After the initial form has been submitted, members can either call in refills using a toll-free phone number or mail a refill request. Certain members can also order refills via the Internet by accessing their mail-order provider's website directly. Initial mail-order prescriptions cannot be ordered online. In selecting drugs for the formulary, our priority is quality before costs. Because Aetna U.S. Healthcare Pharmacy Management is not owned by a pharmaceutical manufacturer, our formulary development is based on an objective, unbiased clinical review of generic and brand-name drugs.
Formulary requirements vary depending on the prescription drug plan design.
Open formularies are available in Aetna U.S. Healthcare non-HMO pharmacy plans and HMO pharmacy plans where filed and approved. In certain HMO service areas, plans are available with a closed formulary. Closed formulary plans do not cover a group of products listed in the Medication Formulary Guide as Formulary Exclusions. A physician may request coverage for a drug on the Formulary Exclusions List by providing the Pharmacy Management Precertification Unit with clinical documentation supporting the drug's medical necessity. Contractually excluded drugs are not covered under closed formulary plans as well.