Learn about your pharmacy benefits
As of September 1, 2018, Aetna Better Health of Louisiana will charge small co-pays on prescription drugs. Louisiana Department of Health now requires copays. Your pharmacy copay depends on the total amount that we would pay the pharmacy for your claim.
Pharmacy cost Your co-pay
$10.00 or less $0.50
$10.01 to $25.00 $1.00
$25.01 to $50.00 $2.00
$50.01 or more $3.00
There are no co-pays for the following pharmacy services:
- Services furnished to pregnant women
- Emergency services
- Family planning services
The following enrollees do not have co-pays:
- Enrollees under 21 years of age
- Enrollees living in a long term care facility
- Enrollees receiving hospice care
- Native Americans
- Alaskan Eskimos
- Home- and Community-Based Waiver recipients
- Women with breast or cervical cancer
Getting your prescriptions
If you need medicine, your provider will choose a drug from our list of preferred drugs.
- Your provider will write you a prescription. Ask your provider to make sure that the medicine is on our list.
- Take your prescription to a pharmacy that’s in our network.
- Show your Aetna Better Health of Louisiana enrollee ID card at the pharmacy.
Find a network pharmacy
Check the list of network pharmacies and look for one in your area. If you need help, just call Enrollee Services at 1-855-242-0802, TTY 711. They’ll be glad to help you find a network pharmacy near you.
Always remember to fill your prescription at a network pharmacy. Your prescriptions won’t be covered at other pharmacies.
Formulary drug list
The formulary is a list of drugs chosen by Louisiana Department of Health's Pharmacy P & T Committee and administered by Aetna Better Health of Louisiana. Drugs are listed as preferred and non-preferred. All non-preferred drugs are required to follow the prior authorization process. There are some preferred drugs that must meet clinical criteria.
There is a subset of drugs not listed on the Louisiana Medicaid Single PDL which may be available for coverage. These drugs typically do not require a prior authorization. Generic substitution is mandated by the state unless a drug is on the preferred drug list as a Brand Name product. Clinical edits, such as quantity limits and age restrictions, may apply to some drug categories.
Enrollees must fill their prescriptions at an Aetna Better Health of Louisiana network pharmacy and follow other plan rules.
To prevent extra costs, check that your medicines are on the preferred drug list (PDL). This is called the formulary. If you have questions, just call Enrollee Services at 1-855-242-0802, TTY 711. Have a list of your prescriptions ready when you call. Ask us to look up your medicines to see if they’re on the list.
Medicines not on the formulary
If your medicine is not on the preferred drug list, there are some things you can do.
- Ask your provider for a similar drug that is on the list.
- Ask your provider to seek “prior authorization” (pre-approval) from Aetna Better Health of Louisiana to cover this medicine. Your provider knows how to do this. This is also known as the exceptions process.
Aetna Better Health also covers certain over-the-counter drugs, if they are on our list. Some are covered, under certain rules. If the rules for that drug are met, Aetna Better Health will cover the drug. Like other drugs, over-the-counter drugs must have a prescription from a provider for them to be covered at no cost to you.
You can look to see if your over-the-counter medicines are on our formulary. You can also check with Enrollee Services at 1-855-242-0802, TTY 711. When you call, have a list of your over-the-counter medicines ready. Ask the representative to look up your medicines to see if they’re on the list.
If your prescriber wants you to have a specialty medication it may be obtained from any pharmacy that is able to fill it in our network. If your routine pharmacy is not able to provide this for you, it can be obtained from a specialty pharmacy.You will need Prior Authorization for these specialty medications (e.g. conditions like cancer, hemophilia, immune deficiency, multiple sclerosis and rheumatoid arthritis.) Your prescriber can complete the prior authorization form.
If you take medicine for an ongoing health condition, you can have your medicines mailed to your home. Aetna Better Health of Louisiana uses CVS Health for this service. You can get these medicines at no cost to you.
If you choose this option, your medicine comes right to your door. You can schedule your refills and reach pharmacists if you have questions. Here are some other features of home delivery.
- Pharmacists check each order for safety.
- You can order refills by mail, by phone, online, or you can sign up for automatic refills.
- Call CVS Healthtoll-free at 1-855-271-6603, Monday to Friday between 7 a.m. and 4 p.m. They will help you sign up for home delivery. If you say it’s OK, they can call your provider to get a prescription.
Your medicine bottle label says how many refills you can have. If your provider hasn’t ordered refills, and you think you need one, you must call him or her at least five days before your medicine runs out. When you call, ask your provider about getting a refill. He or she may want to see you first.
Questions to ask about your medicines
Aetna Better Health of Louisiana wants you to be as healthy as possible. And you’ll want to know more about the different medicines you take. To help you, here’s a list of questions you should always ask your provider when he or she gives you a prescription:
- Why am I taking this medicine?
- What is it supposed to do for me?
- How should I take this medicine? When? For how many days?
- Are there any side effects or possible allergic reactions to this medicine?
- What should I do if I have a side effect or allergic reaction?
- What will happen if I don't take this medicine?
Carefully read the drug information given with your medicine. It will tell you what you should and shouldn’t do while taking the medicine. If you still have questions after you get your medicine, ask to speak with the pharmacist or call your provider.