Depending on the coverage plan, Aetna follows many of the typical guidelines when it comes to prescription drug coverage, states Aetna. As long as the drug requested is not considered to be experimental or unsafe for consumption, there is a good chance it is covered by Aetna.
Some common drugs covered by Aetna include penicillin, insulin and Cipro. In order for a medication to be covered by Aetna, it must be recognized by the U.S. Food and Drug Administration or other professional medical organizations, states Aetna. The company may choose to deny coverage for prescriptions that are actually medical devices rather than medicines. For instance, glucose monitors may not be covered by Aetna. Certain medications may also not be covered if there are over-the-counter medications that serve the same purpose and achieve the same results.
In order to be reimbursed for out-of-pocket drug expenses, including prescriptions from a pharmacy outside of Aetna's network, all receipts must be kept and submitted, notes Aetna. The percentage of the prescription total that Aetna pays depends on the employer's chosen rate of coverage as well as the employee's chosen plan, which could depend on the number of people who require coverage and the age of the insured person.