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What Is Covered By Aetna

Because of the transition from Anthem, there will be questions about whether employees’ preferred doctors, facilities, pharmacies, and medications are covered in Aetna’s network. While transitions always bring an element of change, the very small coverage disruption between Anthem and Aetna (between 1-3%) was a primary consideration in switching insurance carriers.

Please follow the simple instructions below to verify what doctors, facilities, pharmacies, and medications are covered by Aetna.

NOTE: Please use the links and follow the instructions below to verify what is covered by Aetna. Because these Aetna webpages are not tailored to Pepperdine, the “Find By Category Tools” at the bottom of these webpages may not be helpful to Pepperdine employees.

 


 

Doctors and Facilities

You can verify whether your primary care physician (PCP), specialists, hospitals, and medical facilities are in-network with Aetna. HMOs only cover in-network providers, and while the high deductible plan allows for out-of-network providers, there is a higher associated cost.

After clicking the appropriate link below, use the “Continue as a Guest” field to search for your doctors and facilities. NOTE: If your preferred doctor or facility does not appear in the directory, please contact Human Resources (benefits@pepperdine.edu) for additional assistance.

 


 

Pharmacies

Many of the largest and most common retail pharmacies are covered in Aetna’s network. To check if your preferred pharmacy is covered, you can click the link below, and select “Aetna National Pharmacy Network (most common)” in the “Select a Plan” field.

 


 

Medication

You can verify whether your prescription medications are covered under Aetna’s formulary (covered drug list), and how much they will cost by using the link below and searching for the brand or generic name.

Definition Tiers

In-Network Copayments

HMOs

 

HDHP

(Copayments do not apply until after the deductible is met.)

"Generics" Tier 1 $15 $10
"Preferred Brands" Tier 2 $35 $30
"Non-Preferred Brands" Tier 3 $60 $50
"Preferred Specialty" and "Non-Preferred Specialty" Tier 4 30% ($150 maximum) 30% ($250 maximum)

Specialty Drugs and Controlled Substances

If you are currently prescribed a controlled substance or specialty drug that requires prior authorization, you will not be able to fill or refill prescriptions until your coverage is effective on January 1, 2024, and your prescriber has provided Aetna with the required precertification. To avoid delays in January, consider asking your doctor to prescribe a 60- or 90-day supply in December.

Medications Not Covered by Aetna

If you are currently taking a prescribed medication that is not covered by Aetna (“Formulary Excluded”), consider talking to your current doctor about alternative prescription(s) that will be covered. If alternative medication is not possible, review the Next Steps information to take action to request an exception.