April 2019 ~

Effective April 1, Aetna will implement several updates to its pharmacy plan drug lists. These changes will affect all Pharmacy Management drug lists, precertification, quantity limits and step-therapy programs.

According to the notice, providers will be able to view the changes as early as April 1. Changes to the Aetna Standard Plan will be available in May. The following changes apply to all plans unless otherwise noted.

Prescription Drug Changes

(UPPER CASE = brand-name medication lower case = generic medication)

abacavir sulfate/lamivudine/zidovudine can fill up to 2/day

abacavir/lamivudine can fill up to 1/day

AFINITOR can fill up to 1/day

AFINITOR DISPERZ can fill up to 1/day

AIMOVIG INJ 140DOSE can fill up to 2 pens/28 days

AIMOVIG INJ 70MG/ML can fill up to 1 pen/28 days

AIRDUO RESPICLICK 113/14 can fill up to 1 inhaler/month

AIRDUO RESPICLICK 232/14 can fill up to 1 inhaler/month

AIRDUO RESPICLICK 55/14 can fill up to 1 inhaler/month

ALDARA can fill up to 1 packet/day

ALKERAN Non-preferred brand drug

ALPHAGAN P 0.15% Non-preferred brand drug

ANAPROX DS must first try naproxen sodium

ANCOBON must first try flucytosine

ARMONAIR RESPICLICK 113 can fill up to 1 inhaler/month

ARMONAIR RESPICLICK 232 can fill up to 1 inhaler/month

ARMONAIR RESPICLICK 55 can fill up to 1 inhaler/month

ASMANEX TWISTHALER can fill up to 1 inhaler/month

ATELVIA Non-preferred brand drug; must first try alendronate 70mg

ATRIPLA can fill up to 1/day

AUGMENTIN Non-preferred brand drug

AUGMENTIN ES-600 Non-preferred brand drug

benzonatate must first try benzonatate 100mg, 200mg

bicalutamide Preauthorization has been removed

BIKTARVY Preferred brand drug; Preauthorization has been removed; can fill up to 1/day

BOSULIF, TAB 100MG can fill up to 4/day

BOSULIF, TAB 400MG can fill up to 1/day

BOSULIF, TAB 500MG can fill up to 1/day

CAPRELSA, TAB 100MG can fill up to 2day

CAPRELSA, TAB 300MG can fill up to 1/day

CASODEX Preauthorization has been removed

COMBIVIR can fill up to 2/day

COMETRIQ KIT 100MG can fill up to 2 caps/day

COMETRIQ KIT 140MG can fill up to 4 caps/day

COMETRIQ KIT 60MG can fill up to 3 caps/day

COMPLERA can fill up to 1/day

DELSTRIGO must first try TRIUMEQ or TIVICAY plus TRUVADA or ISENTRESS plus TRUVADA or BIKTARVY

DEXPAK 10 DAY must first try dexamethasone

DEXPAK 13 DAY must first try dexamethasone

DEXPAK 6 DAY must first try dexamethasone

DICLEGIS Preauthorization required

DISALCID Not covered under pharmacy benefit DULERA can fill up to 2 inhalers/month

EDURANT can fill up to 1/day

EMTRIVA can fill up to 1/day

EPIDUO must first try adapalene-benzoyl peroxide

EPIVIR HBV Non-preferred brand drug EPZICOM can fill up to 1/day

EVOTAZ can fill up to 1/day

FEXMID must first try cyclobenzaprine

fluticasone propionate/salmeterol can fill up to 1 inhaler/month

FURADANTIN must first try nitrofurantoin

GENVOYA must first try TRIUMEQ or TIVICAY plus TRUVADA or ISENTRESS plus TRUVADA or BIKTARVY

GILOTRIF can fill up to 1/day

ICLUSIG TAB 15MG can fill up to 2/day

ICLUSIG TAB 45MG can fill up to 1/ ay

IMBRUVICA CAP 140MG can fill up to 4/day

imiquimod can fill up to 1 packet/day

imiquimod pump can fill up to 1 pump/month

INLYTA TAB 1MG can fill up to 6/day

INLYTA TAB 5MG can fill up to 4/day

JUXTAPID can fill up to 1/day

KENALOG must first try triamcinolone; can fill up to 100 gm/30 days

lamivudine/zidovudine can fill up to 2/day

LENVIMA 10 MG DAILY DOSE can fill up to 1/day

LENVIMA 14 MG DAILY DOSE can fill up to 2/day

LENVIMA 18 MG DAILY DOSE can fill up to 3/day

LENVIMA 20 MG DAILY DOSE can fill up to 2/day

LENVIMA 24 MG DAILY DOSE can fill up to 3/day

LENVIMA 8 MG DAILY DOSE can fill up to 2/day

LEXAPRO must first try escitalopram

LIALDA Non-preferred brand drug; must first try mesalamine

LIPITOR must first try 2 of atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin or rosuvastatin

LOKELMA must first try sodium polystyrene sulfonate

LYNPARZA CAP 50MG can fill up to 16/day

MAKENA must first try hydroxyprogesterone

MEKINIST TAB 0.5MG can fill up to 3/day

MEKINIST TAB 2MG can fill up to 1/day

MEPHYTON Non-preferred brand drug metaxalone; must first try cyclobenzaprine

MIGERGOT must first try 3 of naratriptan, rizatriptan, sumatriptan, or zolmitriptan

MOBIC must first try meloxicam

NAMENDA XR Non-preferred brand drug; must first try memantine

NEXAVAR can fill up to 4/day

NEXIUM must first try pantoprazole, esomeprazole, lansoprazole or omeprazole

NILANDRON Non-preferred brand drug PIFELTRO; can fill up to 1/day

POMALYST can fill up to 21/month

PREZCOBIX can fill up to 1/day

PROTOPIC Non-preferred brand drug RENVELA Non-preferred brand drug REVLIMID; can fill up to 1/day

salsalate Not covered under pharmacy benefit SPRYCEL TAB 100MG; can fill up to 1/day

SPRYCEL TAB 140MG can fill up to 1/day

SPRYCEL TAB 20MG can fill up to 3/day

SPRYCEL TAB 50MG can fill up to 2/day

SPRYCEL TAB 70MG can fill up to 2/day

SPRYCEL TAB 80MG can fill up to 1/day

STIVARGA can fill up to 84/month

STRIBILD must first try TRIUMEQ or TIVICAY plus TRUVADA or ISENTRESS plus TRUVADA or BIKTARVY; can fill up to 1/day

SUTENT CAP 37.5MG can fill up to 1/day

SUTENT CAP 50MG can fill up to 1/day

SYLATRON can fill up to 4 inj/month

SYMFI can fill up to 1/day

SYMFI LO can fill up to 1/day

SYMTUZA must first try TRIUMEQ or TIVICAY plus TRUVADA or ISENTRESS plus TRUVADA or BIKTARVY; can fill up to 1/ day

TAFINLAR can fill up to 4/day

TAMIFLU must first try oseltamivir

TAPERDEX 6-DAY must first try dexamethasone

TARCEVA TAB 100MG can fill up to 1/day

TARCEVA TAB 150MG can fill up to 1/day

TARCEVA TAB 25MG can fill up to 2/day

TASIGNA can fill up to 4/day

triamcinolone aer spray can fill up to 100 gm/30 days

TRIUMEQ can fill up to 1/day

TRIZIVIR can fill up to 2/day

TRUVADA can fill up to 1/day

TYKERB can fill up to 6/day

VELTASSA must first try sodium polystyrene sulfonate

VISCO-3 must first try ORTHOVISC, MONOVISC, EUFLEXXA

VIVELLE-DOT Non-preferred brand drug; must first try estradiol

VOLTAREN Non-preferred brand drug; must first try diclofenac sodium

VOTRIENT can fill up to 4/day

WELCHOL must first try colesevelam

XTANDI can fill up to 4/day

ZIANA Non-preferred brand drug

ZOLINZA can fill up to 4/day

ZYCLARA can fill up to 1 packet/day

ZYCLARA PUMP can fill up to 1 pump/month

ZYDELIG can fill up to 2/day

ZYKADIA can fill up to 3/day; Not covered at mail-order pharmacy

ZYLOPRIM must first try allopurinol

More information can be found on Humana’s Formularies & Pharmacy Clinical Policy Bulletins page.

 

Source(s): Aetna; Aetna Formularies & Pharmacy Clinical Policy Bulletins page;