What Tiers Does Aetna Place Brand Drugs On | Understanding Prescription Costs

Prescription drug costs can be confusing for many. Aetna, a leading health insurer, organizes medications into tiers to determine your out-of-pocket costs. Understanding these tiers helps you manage expenses effectively.

Aetna’s drug tiers categorize brand and generic drugs based on cost and coverage. Brand drugs typically fall into higher tiers, affecting copays or coinsurance. Knowing how Aetna structures its formulary clarifies what you’ll pay.

This article explains what tiers Aetna places brand drugs on and how it impacts you. It covers tier structures, costs, and tips for saving on prescriptions. Let’s dive into Aetna’s system for clear insights.

Understanding Aetna’s Drug Formulary

Aetna’s formulary is a list of covered prescription drugs. It includes both generic and brand-name medications. The formulary organizes drugs into tiers that determine your costs.

You can find your plan’s formulary on Aetna’s website or member portal. Logging in personalizes your search for coverage details. Always check your specific plan, as tiers vary.

What Are Drug Tiers?

Drug tiers are levels that classify medications based on cost and type. Lower tiers typically include generics with lower copays. Higher tiers include brand drugs with higher costs.

Aetna plans may have two to five tiers, depending on the plan. Each tier has different copays or coinsurance. Understanding tiers helps predict prescription expenses.

What Tiers Does Aetna Place Brand Drugs On

Aetna places brand drugs on higher tiers, typically Tier 3, Tier 4, or Tier 5. Preferred brand drugs are usually on Tier 3 with moderate copays. Non-preferred brand drugs fall on Tier 4, and specialty brand drugs are on Tier 5 with the highest costs.

Your plan’s formulary details exact tier placements. Use Aetna’s drug search tool or call 1-800-872-3862 to confirm. Brand drugs cost more than generics, often in Tier 1 or 2.

Typical Aetna Drug Tier Structure

Aetna’s common tier structure includes:

• Tier 1: Generic drugs with the lowest copays.
• Tier 2: Preferred generics or low-cost brand drugs.
• Tier 3: Preferred brand drugs with moderate copays.
• Tier 4: Non-preferred brand drugs with higher costs.
• Tier 5: Specialty drugs for complex conditions.

Some plans use fewer tiers, like three or four. Check your plan’s formulary for specifics. Tiers affect your out-of-pocket costs significantly.

Costs Associated with Brand Drug Tiers

Brand drugs on Tier 3 may have copays of $30–$50. Tier 4 non-preferred brands can cost $60–$100 or more. Tier 5 specialty drugs often involve coinsurance, like 25%–33% of the drug’s cost.

Costs depend on whether you’ve met your deductible. Preventive drugs may have lower or no copays. Log into Aetna’s member portal for exact pricing.

Aetna Drug Tier Contact Information

Below is a table of key Aetna contacts for drug tier inquiries:

Use these numbers to check tier placements or coverage. Have your member ID ready. The Aetna website offers a drug search tool for details.

Specialty Drugs and Tier 5

Specialty drugs treat complex conditions like cancer or rheumatoid arthritis. Aetna places these brand drugs on Tier 5. They often require special handling or mail-order delivery.

Costs can be high, with coinsurance up to 33%. CVS Specialty Pharmacy handles these drugs. Call 1-800-237-2767 for support or delivery options.

Coverage Rules for Brand Drugs

Some brand drugs have coverage rules. These include:

• Prior Authorization (PA): Requires doctor approval before coverage.
• Step Therapy (ST): You must try a generic first.
• Quantity Limits (QL): Caps the amount you can get.

Check your formulary for PA, ST, or QL notations. Your doctor can request exceptions if needed. These rules ensure cost-effective and safe use.

Finding Your Drug’s Tier

Log into Aetna’s member portal at aetna.com to check your drug’s tier. Enter the drug name in the search tool. Results show coverage, tier, and any limits.

You can also call 1-800-872-3862 for personalized help. The formulary lists drugs in italics (generics) or uppercase (brands). Always confirm with your plan’s specifics.

Saving on Brand Drug Costs

Ask your doctor about generic alternatives in Tier 1 or 2. These have lower copays than brand drugs. Use in-network pharmacies, like CVS, for savings.

Aetna’s mail-order service offers 90-day supplies at reduced costs. Preventive drugs may be covered without cost-sharing. Check your plan for these options.

Medicare Part D and Aetna Tiers

Aetna’s Medicare Part D plans, like SilverScript, use similar tier structures. Brand drugs are typically on Tier 3 (preferred) or Tier 4 (non-preferred). Specialty drugs are on Tier 5.

Copays range from $5–$47 for Tier 3, higher for Tier 4. Use the Medicare Plan Finder or call 1-855-335-1407 to check tiers. Extra Help subsidies may lower costs.

Formulary Exceptions for Brand Drugs

If your brand drug isn’t covered, request a formulary exception. Your doctor must show medical necessity. Approved exceptions place the drug on Tier 4 for non-preferred brands.

Submit requests to Aetna at 1-855-582-2025 or fax 1-855-330-1716. Temporary supplies may be available in certain cases. Check your Evidence of Coverage for details.

Using Aetna’s Pharmacy Benefits

Aetna’s pharmacy benefits include mail-order and retail options. CVS Caremark Mail Service offers 90-day supplies for convenience. In-network pharmacies ensure lower copays.

Log into your member portal to manage prescriptions. The Aetna Health app helps track costs and refills. Register with your member ID for access.

Preventive and Chronic Drug Lists

Aetna covers some preventive drugs at no cost. These include drugs for high blood pressure or cholesterol. They’re often on lower tiers, even for brands.

Chronic condition drugs may have fixed copays. Check the formulary’s preventive or maintenance lists. This reduces costs for long-term medications.

Appealing Coverage Decisions

If Aetna denies coverage for a brand drug, appeal within 180 days. Submit via the member portal or mail with supporting documents. Appeals take 30–60 days to resolve.

For urgent cases, request an expedited review. Call 1-800-872-3862 for assistance. Keep records of all communications for follow-ups.

Brand Drugs and Plan Variations

Aetna’s tier structure varies by plan type, like HMO or PPO. Employer plans may have custom formularies. Self-insured plans might exclude certain brand drugs.

Check your plan’s formulary for accurate tier placement. Contact your employer’s HR for specific details. This ensures you know your costs.

Tips for Managing Prescription Costs

Work with your doctor to choose lower-tier drugs. Use Aetna’s cost estimator tool for price comparisons. Opt for 90-day supplies to save on refills.

Check if your plan qualifies for an HSA. HSA funds can cover brand drug copays. Always use in-network pharmacies for maximum savings.

Summary

Aetna places brand drugs on higher tiers, typically Tier 3 (preferred brands), Tier 4 (non-preferred brands), or Tier 5 (specialty drugs). Costs vary, with copays or coinsurance higher for upper tiers. Use Aetna’s drug search tool or call 1-800-872-3862 to confirm tiers. Generics, preventive drugs, and mail-order options help save money. Understanding your plan’s formulary and coverage rules ensures affordable access to brand-name medications.

FAQ

What tiers does Aetna place brand drugs on?
Aetna places preferred brand drugs on Tier 3, non-preferred on Tier 4, and specialty brands on Tier 5. Copays or coinsurance increase with higher tiers. Check your formulary or call 1-800-872-3862.

How do I find my drug’s tier with Aetna?
Log into Aetna’s member portal or use the drug search tool. Enter the drug name to see its tier and costs. Alternatively, call 1-800-872-3862 for help.

Can I get a brand drug covered if it’s not on the formulary?
Request a formulary exception via your doctor for medical necessity. Submit to 1-855-582-2025. Approved drugs are typically placed on Tier 4.

Are there ways to lower brand drug costs with Aetna?
Ask for generics, use in-network pharmacies, or opt for mail-order 90-day supplies. Preventive drugs may have no cost-sharing. Check your plan’s formulary for savings.

What if Aetna denies coverage for my brand drug?
Appeal within 180 days via the member portal or mail. Include supporting documents and call 1-800-872-3862 for guidance. Appeals take 30–60 days to resolve.