Get to know your pharmacy benefits
Learn key points about your prescription drug benefits.
Get to know your pharmacy benefits
Learn key points about your prescription drug benefits.
Your pharmacy plan has four tiers of benefits, ranging from generic medicines to specialty drugs.
As part of your Aetna® medical plan, your prescription drugs are covered under the Aetna Standard Plan: Department of Defense formulary. The formulary is a list of medicines that are covered by your plan. The formulary also lists which tier each drug falls into, which affects how much it costs.
The four-tier pharmacy plan for the Department of Defense offers:
- Coverage for most medicines
- Mail-order pharmacy services
- Personal support for specialty medicine needs
- Your personal member website with tools to help you find what you need
- 24/7 pharmacy help by calling the phone number on your member ID card
Under this plan, you can fill short-term prescriptions at in-network pharmacies (up to a 30-day supply) and long-term prescriptions through the mail-order service (up to a 90-day supply) or at a CVS Pharmacy®. For certain maintenance medications, you’ll be required to fill a 90-day supply through the Maintenance Choice program. Learn more about Maintenance Choice.
Understanding the four-tier pharmacy plan
No matter where you fill a prescription, the amount you’ll pay depends on the tier of the covered drug. For example, generic medicines, which are Tier One drugs in the DoD plan, usually cost less than brand-name drugs or specialty drugs (such as those that are injected or inhaled).
In your plan materials, you can see what medicines are covered by your plan and how much you’ll have to pay. What you pay depends on what type of plan you choose — a high-deductible health plan (HDHP) or a non-HDHP.
To compare the cost of medicines: Log in to Aetna.com and go to Pharmacy, then select Check medication costs.
Prescription drug benefits with an HDHP medical plan
This chart explains drug costs with an HDHP medical plan. Note: While we work hard to limit cost increases for employees from year to year, we must also manage the ever-increasing cost to our organization.
This chart lists what you’ll pay after meeting your calendar-year deductible, which includes pharmacy. The max refers to the most you’ll pay for up to a 30-day or 90-day supply of a medicine in that tier.
| Tier and drug type | At any network pharmacy for up to a 30-day supply | With Maintenance Choice or Mail Service Pharmacy for up to a 90-day supply* |
|---|---|---|
| Tier One: Generic drugs | 0% after deductible | 0% after deductible |
| Tier Two: Preferred brand-name drugs | 35% after deductible; $75 max | 35% after deductible; $150 max |
| Tier Three: Non-preferred brand-name drugs** | 50% after deductible; $125 max | 50% after deductible; $250 max |
| Tier Four: Specialty drugs | 50% after deductible; $125 max | — |
| Fill limit for maintenance drugs | Limit 2 fills | No limit |
*With Maintenance Choice, it’s mandatory that you get a 90-day supply of maintenance medications by using either CVS Caremark® Mail Service Pharmacy or a CVS Pharmacy® near you. Learn more about Maintenance Choice.
**Your pharmacy will automatically fill your prescription with a generic drug if one is available.
Note: 30-day supply prescription fills are only available in the United States, Puerto Rico, Guam and the U.S. Virgin Islands.
Prescription drug benefits with a non-HDHP medical plan
This chart explains drug costs with a non-HDHP medical plan. Note: While we work hard to limit cost increases for employees from year to year, we must also manage the ever-increasing cost to our organization.
This chart lists what you’ll pay as a copay and/or percentage of the drug cost. The min/max refers to the least or most you’ll pay for up to a 30-day or 90-day supply of a medicine in that tier.
| Tier and drug type | At any network pharmacy for up to a 30-day supply | With Maintenance Choice or Mail Service Pharmacy for up to a 90-day supply* |
|---|---|---|
| Tier One: Generic drugs | $10 copay | $20 copay |
| Tier Two: Preferred brand-name drugs | 25% (min $45 / max $70) | 25% (min $90 / max $140) |
| Tier Three: Non-preferred brand-name drugs** | 35% (min $75 / max $200) | 35% (min $150 / max $400) |
| Tier Four: Specialty drugs | 40% of negotiated price*** (min $60 / max $125) | — |
| Fill limit for maintenance drugs | Limit 2 fills | No limit |
*With Maintenance Choice, it’s mandatory that you get a 90-day supply of maintenance medications by using either CVS Caremark Mail Service Pharmacy or a CVS Pharmacy near you. Learn more about Maintenance Choice.
**Your pharmacy will automatically fill your prescription with a generic drug if one is available.
***Participating pharmacies agree to charge discounted prices for prescriptions filled by Aetna members. Your share of Tier Three and Tier Four drug costs is a percentage of these discounted (or “negotiated”) prices.
Note: 30-day supply prescription fills are only available in the United States, Puerto Rico, Guam and the U.S. Virgin Islands.
Understanding the Maintenance Choice program
The Maintenance Choice program offers convenience and discounted rates for maintenance medications, which are medicines you take on a regular basis.
With this program, you are required to get a 90-day supply of medications on the Maintenance Choice list. After two 30-day fills, the plan will no longer cover additional 30-day fills. If you do not get a 90-day supply through Maintenance Choice, you will be responsible for paying the full cost of the next refill of the drug, and it won’t count toward your out-of-pocket maximum.
The good news: With this program, you’ll pay the same amount for a 90-day supply as you would for two 30-day supplies. It’s like getting a month free!
You have two ways to fill a 90-day supply:
- Use the CVS Caremark® Mail Service Pharmacy. This service lets you order a 90-day supply of maintenance medications to be delivered to your home or any other address you choose. Shipping is free and the packaging is confidential. Mail-order pharmacies use the same quality and accuracy checks for prescriptions as retail pharmacies. To learn more, visit Aetna.com > Pharmacy or call CVS Caremark Mail Service Pharmacy at 1-888-792-3862.
- Visit a CVS Pharmacy® retail store. Pick up your 90-day supply from a CVS Pharmacy location near you. Find a CVS Pharmacy near you. Note: Members in Hawaii only may use a Longs Drugs location.
Questions about pharmacy benefits?
Read the Pharmacy coverage FAQ (frequently asked questions).
Contact information