As a pharmacist, how can I support the Aetna preferred drug list (also called a formulary) and Precertification and Step-Therapy programs?
As a pharmacist participating in our network, you play an important role in caring for Aetna members. When a member presents a prescription for a drug that requires precertification or prerequisite therapy or that is on the Formulary Exclusions List and may not be covered for some members, please intervene on his/her behalf by contacting the prescribing physician. If the physician wishes to request a medical exception so that a Formulary Exclusions List drug or step-therapy drug will be covered, direct him/her to the Aetna Pharmacy Management Precertification Unit. The physician can then fax the request to 1-800-408-2386 or can phone 1-800-414-2386 to request coverage. To learn about Pharmacy Management’s guidelines for determining health care coverage for selected outpatient prescription drugs on the Formulary Exclusions List or those drugs requiring precertification or step-therapy, see our Pharmacy Clinical Policy Bulletins. In cases where a physician has prescribed an analgesic or
