Aetna is the Prescription Benefit Manager (PBM) chosen to provide cost-effective prescription benefit services to you.

You have access to a national network of participating pharmacies. This pharmacy network is designed to provide you convenient access to chain and independent pharmacies in your area at competitive costs to you and your benefit plan.
Aetna’s goal is to provide the highest quality pharmaceutical care, at lower costs. The most effective way to control costs are through the use of generic drugs and a Aetna Preferred Drug List (3-Tier Formulary). Ask your physician to authorize a generic substitution whenever possible. When a generic is not available, there may be more than one brand name drug that may be appropriate for you. That is why this 3-Tier Formulary was developed.  Aetna’s Customer Service Representatives can help answer questions you or your pharmacist may have.

Prescription Co-pay:

Your prescription benefit provides lower cost through Mail Order.

• Aetna Rx Home Delivery is a Mail Order service that provides a convenient delivery option for medications that treat chronic conditions like high blood pressure and diabetes. Through Aetna’s Rx Home Delivery, you can typically request up to a three-month supply at lower out of pocket costs than if you had these prescriptions filled at a retail pharmacy.

Mail Order Prescription Co-pay:

EPISD in conjunction with Aetna utilizes the following programs specifically designed to comply with FDA guidelines for safe and effective use of prescription medications.

STEP Therapy - Implemented October 1, 2005
If the diagnosis is recent, the Medical Plan requires, that if an Over the Counter (OTC) medication exists for the effective treatment of the diagnosed medical condition, the patient must use the OTC before a prescription for a first line medication can be dispensed.  Employees must first inform their physician or nurse practitioner that their employer participates in the STEP Therapy Program.  The physician or nurse practitioner should provide you with a Prescription Order for the OTC medication or call it in to your pharmacy.  When you pick up the OTC medication, you will be charged the generic co-payment. 

Quantity Limitations - Implemented October 1, 2005
The Quantity Limitations Program introduces safety as well as cost savings.  Quantity Limitations are based upon current medical findings, manufacturer-labeling information, managed care practices and FDA guidelines.  Products are recommended for appropriate dosage based on medical necessity.
 
Dosage Optimization - Implemented March 1, 2006
One of the methods that Aetna uses to ensure safe and appropriate, yet cost-effective drug therapy is through the dosage optimization program.  The goal of dosage optimization is to ensure better compliance with members taking their medications.   Studies have proven that when members are recommended to take their medications once a day, they will have better outcomes than if they were to take the same medication multiple times a day.

Maintenance at Mail-Order - Implemented March 1, 2006
Aetna maintains a listing of drugs that are considered to be safe to be dispensed in quantities greater than one month’s supply.  These drugs are generally those that are taken life-long for the member and include cardiovascular drugs, hormones, anti-seizure medications and many others.  Many therapeutic categories of drugs are intended to be dispensed in maintenance quantities, and drugs in other categories are not appropriate to be dispensed in larger quantities for safety reasons.

For more information on these programs or questions regarding your Pharmacy Benefit Manager, please visit the EPISD Employee Benefits website at Pharmacy Information, or click here to visit Aetna’s link to Drugs and Prescriptions