Find out if we cover the drugs you take and estimate how much you’ll pay for them.
Check our drug list
See if your plan covers the prescription drugs you take
The formulary (list of covered drugs) will tell you:
-
The drugs we cover
-
The tier a drug is on
-
Any limits or requirements before we cover the drug
-
If the drug is eligible for home delivery
Non-Part D Supplemental Benefit
With the Sherwin Williams Aetna Medicare Advantage plan, you get supplemental benefits to cover cough and cold prescription drugs not covered by Medicare.
The amount you pay when you fill a prescription with the Non-Part D Supplemental Benefit does not count toward your total drug costs. (This amount does not help you qualify for catastrophic coverage.)
If you are receiving Extra Help to pay for your prescriptions, it will not apply for these supplemental benefits.
Other prescription drug information
Changes to the formulary (list of covered drugs)
We review our drug list on a monthly basis and make changes as necessary. Most changes are positive. An example would be adding new generics that have come on the market.
Sometimes we have to remove a drug from our formulary. An example is if the U.S. Food and Drug Administration (FDA) says a drug is unsafe or the drug maker takes the drug off the market.
Prior authorization, quantity limits and step therapy
Some drugs have rules you need to follow before we cover them. These include:
-
Prior authorization: You or your doctor must get approval from us before we cover the drug.
-
Step therapy: We require you to try another drug first before we cover your drug.
-
Quantity limits: For certain drugs, we limit the amount you can get.
You and your doctor can ask us to make an exception to one of our coverage rules. This includes requesting an exception to a prior authorization, step therapy or quantity limit rule.
Transition rules
There may be times where you’re taking a drug that either isn’t on our drug list or has special rules before we cover it. Learn about our transition process to see if you’re eligible for a short-term supply of medication while you move to a drug we do cover. This temporary supply allows you to work with your doctor to either transition to a new drug or request an exception to continue your current drug.
