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Aetna Changes Coverage for
Self-Injectable Medications
One of Aetna’s most important goals is to control health care expenses as much as possible. If Aetna is successful at doing so, you benefit through lower rates and they remain competitive in the insurance market.
As part of Aetna’s cost-savings strategy, coverage for certain self-injectable medications will now be covered under your prescription drug benefit, rather than your medical benefit.
These self-injectable drugs tend to be extremely expensive, often thousands of dollars per monthly regimen, and require special handling, storage and shipment. By changing the way in which they are covered, Aetna can better control how much they pay for the drug. In addition, they will also be charging a copay which will help offset costs on a collective basis.
Self-injectable medications included in this change:
- Those used to treat medical conditions such as hemophilia, growth hormone deficiency, multiple
sclerosis, and hepatitis C.
- Examples of these medications include Procrit, Epogen, Neupogen, and Neulasta.
- Blood modifiers to treat cancer and kidney disease are not included in this change, and will continue
to be paid for under the medical coverage.
- For a complete listing, log on to Aetna Navigator at www.myaetna.com, or call Aetna Specialty Pharmacy
at 1-866-782-2779.
Impact of this change:
- These medications will require a pharmacy copayment, whereas in the past they did not.
- The majority of these medications must be filled through Aetna Specialty Pharmacy.
- For more information, go to www.aetnaspecialtypharmacy.com.
- Some of these medications can be filled at the retail pharmacy, provided they carry them. These medications will be noted on Aetna Navigator.
Aetna will not pay for these self-injectable medications if they are supplied by your doctor. However, if you
are not comfortable with self-injection, you may schedule an appointment with you doctor to perform this
service. If you do so, you may be billed an additional office visit copay from your doctor.
If you or your family members have any questions about the administration of a self-injectable medication, contact Aetna Specialty Pharmacy at 1-866-782-2779. Health care professionals and pharmacists are available 24 hours a day, 7 days a week, to assist you.
If you have any questions about this topic, please contact your RSI Benefit Service Specialist at 1-800-394-6111.
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