Aetna (now part of CVS Health) maintains multiple formulary lists depending on your plan type, including commercial, Medicare, and Medicaid plans. The integration with CVS gives Aetna members access to preferred pricing at CVS pharmacies. Aetna's 2026 formulary emphasizes biosimilar adoption and value-based drug pricing.

Key Facts

Aetna uses a 5-tier formulary: Value Generic, Generic, Preferred Brand, Non-Preferred Brand, and Specialty
CVS Pharmacy is the preferred pharmacy for most Aetna plans, offering lower copays
Aetna's Pharmacy Clinical Policy Bulletins outline prior authorization criteria for each drug
Biosimilars are preferred over reference biologics on most Aetna plans in 2026
Digital prior authorization through Aetna's provider portal reduces approval time to under 24 hours
Aetna covers most ACA-mandated preventive drugs at $0 copay

Open Enrollment Reminder

ACA marketplace enrollment runs November 1 to January 15. Medicare Annual Enrollment is October 15 to December 7. Compare formularies for your medications before choosing a plan.

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Check Your Specific Plan's Formulary

Coverage varies by plan. Use our formulary checker tool to look up your exact copay and restrictions.

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Sources and standards behind this page

Drug coverage in the United States is governed by published rules rather than by any one insurer's summary, and the sources below are the primary ones. They are linked so a reader can check a claim without taking this page's word for it.

This page describes how coverage and formularies work. It is not medical advice, and a reader's own plan documents and prescriber decide what applies to them.

Frequently Asked Questions

How does Aetna's CVS preferred pharmacy network affect my costs?

Filling prescriptions at CVS pharmacies typically results in lower copays and coinsurance compared to non-preferred pharmacies. For some plans, certain medications are only covered at CVS or CVS mail-order. Check your plan details for the exact cost difference.

Does Aetna require step therapy?

Yes, Aetna uses step therapy for many drug classes. This means you may need to try a preferred (usually less expensive) medication first before Aetna will cover a more expensive alternative. Your doctor can request a step therapy exception if clinically appropriate.

How do I appeal a drug denial from Aetna?

You or your doctor can submit an appeal through Aetna's member portal, by fax, or by mail. Include supporting clinical documentation. Aetna must respond to standard appeals within 30 days (72 hours for urgent/expedited appeals). You can also request an external review if the internal appeal is denied.

Related Resources

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