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NU-SHIP Changes for 2020-21

Aetna's communication strategy ensures that members are prepared for changes. In order to comply with state requirements, all subscribers will be notified 60-days in advance of all changes.  Upon notification of a group’s renewal, impacted members and their providers will receive a targeted letter. When renewal decisions are made, less that 60-days notice, targeted letters may arrive after the effective date.

 

Notification Timing Communication Details

Mailing 1

All subscribers

60 days before renewal

All subscribers will receive a letter with the full summary of changes and a link to their drug search tool. Subscribers that have provided a valid email address will also receive an email copy of the letter.

Mailing 2

Targeted members

~30 days after notification of a group's renewal

Targeted members will receive a letter with a summary of impact (e.g., tiering, edits) based on their new formulary. Physician notifications will be sent when required by state mandate.

sample-member-letters

A Smooth Member Transition for Members

member-transition-chart.png

 

Please see the full list of medications that will be impacted by the formulary change for the 2020-21 academic/plan year.
  • Tier 1 Co-Payment = $10
  • Tier 2 Co-Payment = $30
  • Tier 3 Co-Payment = $60
  • X = No Longer Covered

Click here to download the full Impacted Drug List file. (DOC)

 

DRUG NAME

COMMON USE

CURRENT TIER

NEW TIER

ATOVAQUONE/PROGUANIL HCL

INFECTION

1

3

CLINDAMYCIN GEL 1%

ACNE

1

3

CLINDAMYCIN LOT 10MG/ML

ACNE

1

3

CLOBETASOL PROPIONATE

SKIN DISORDERS

1

3

DESVENLAFAXINE ER

DEPRESSION

1

3

ADAPALENE

ACNE

1

3

CLINDAMYCIN LOT 1%

ACNE

1

3

CLINDAMYCIN SOL 1%

ACNE

1

3

DESONIDE

SKIN DISORDERS

1

3

CELECOXIB

ARTHRITIS AND PAIN

1

3

LATUDA

PSYCHIATRIC DISORDERS

2

X

LEVALBUTEROL TARTRATE HFA

ASTHMA

1

3

FLUTICASONE PROPIONATE/SALMETE

ASTH MA

1

X

CLARAVIS

ACNE

1

3

ELETRIPTAN HYDROBROMIDE

MIGRAINE HEADACHE

1

3

LOTEMAX SM

EYE DISORDERS

2

X

LIDOCAINE

PAIN - TOPICAL

1

3

CLINDAMYCIN/BENZOYL PEROXIDE

ACNE

X

3

TACROLIMUS

SKIN DISORDERS

1

3

AMNESTEEM

ACNE

1

3

AZELAIC ACID

SKIN DISORDERS

1

3

GLYCOPYRROLATE

GASTROINTESTINAL DISORDERS

1

3

MOMETASONE CRE 0.1%

SKIN DISORDERS

1

3

DUREZOL

EYE DISORDERS

2

X

CLINDAMYCIN GEL TRETINOI

ACNE

1

X

WIXELA INHUB

ASTHMA

1

X

XOFLUZA

INFECTION

3

X

ZOLPIDEM TARTRATE ER

SEDATIVE/HYPNOTIC

1

3

TARGADOX

INFECTION

3

X

TOLTERODINE TARTRATE ER

KIDNEY/BLADDER DISORDERS

1

3

CLINDAMYCIN PHOSPHATE/BENZOYL

ACNE

X

3

BONJESTA

NAUSEA AND VOMITING

3

X

MOMETASONE OIN 0.1%

SKIN DISORDERS

1

3

METRONIDAZOL GEL 1%

SKIN DISORDERS

1

3

IVERMECTIN CRE 1%

SKIN DISORDERS

1

3

KETONE

DIAGNOSTIC AID

1

3

FREESTYLE

DIABETES

3

X

FLUOCINONIDE CRE 0.05%

SKIN DISORDERS

1

3

FLUTICASONE CRE 0.05%

SKIN DISORDERS

1

3

BETAMETHASONE VALERATE

SKIN DISORDERS

1

3

AZELEX

ACNE

3

X

ABSORICA

ACNE

3

X

ACYCLOVIR CRE 5%

SKIN DISORDERS

1

3

ACYCLOVIR OIN 5%

SKIN DISORDERS

1

3

BUT/APAP/CAF CAP

PAIN

1

X

TRETINOIN GEL 0.05%

ACNE

1

3

RESTASIS

EYE DISORDERS

2

X

ZYLET

EYE DISORDERS

3

X

VELTIN

ACNE

3

X

VENTOLIN HFA

ASTHMA

2

X

URSODIOL TAB 250MG

GASTROINTESTINAL DISORDERS

1

3

URSODIOL TAB 500MG

GASTROINTESTINAL DISORDERS

1

3

VANCOMYCIN HYDROCHLORIDE

INFECTION

1

3

VENLAFAXINE TAB 37.5 ER

DEPRESSION

1

X

RAYOS

INFLAMMATION

3

X

TRANEXAMIC ACID

BLOOD MODIFIER

1

3

TINIDAZOLE

INFECTION

1

3

NORITATE

SKIN DISORDERS

3

X

NUVESSA

VAGINAL PRODUCTS

3

X

OLOPATADINE SPR 0.6%

ALLERGY

1

3

ORACEA

SKIN DISORDERS

2

3

PALIPERIDONE ER

PSYCHIATRIC DISORDERS

1

3

PAZEO

EYE DISORDERS

2

X

QBREXZA

SKIN DISORDERS

3

X

QNASL CHILDRENS

ALLERGY

3

X

QUETIAPINE FUMARATE ER

PSYCHIATRIC DISORDERS

1

3

RETIN-A MICRO PUMP

ACNE

2

3

BYSTOLIC

CARDIOVASCULAR

2

X

BUPROPION TAB 450MG XL

DEPRESSION

1

3

CALCIPOTRIEN OIN 0.005%

PSORIASIS

1

3

CALCIPOTRIEN SOL 0.005%

PSORIASIS

1

3

CAMBIA

MIGRAINE HEADACHE

3

X

CLINDAMYCIN AER 1%

ACNE

1

3

CLINDAMYCIN GEL TRETINOI

ACNE

1

3

CICLOPIROX

SKIN DISORDERS

1

3

CIPROFLOXACIN

EAR DISORDERS

1

3

CLOCORTOLONE PIVALATE

SKIN DISORDERS

1

3

CYMBALTA

DEPRESSION

3

X

DESOXIMETASONE

SKIN DISORDERS

1

3

AMPHETAMINE SULFATE

ADHD

1

3

ALBENDAZOLE

INFECTION

1

3

AZELASTINE SPR 0.15%

ALLERGY

1

3

ATROPINE SULFATE

EYE DISORDERS

1

X

AZASITE

EYE DISORDERS

2

X

BELSOMRA

SEDATIVE/HYPNOTIC

3

X

BEPREVE

EYE DISORDERS

3

X

FLUOCIN ACET OIL 0.01%

EAR DISORDERS

1

3

FLUOCINONIDE OIN 0.05%

SKIN DISORDERS

1

3

FABIOR

ACNE

3

X

FETZIMA

DEPRESSION

3

X

ECONAZOLE NITRATE

SKIN DISORDERS

1

3

DIHYDROERGOTAMINE MESYLATE

MIGRAINE HEADACHE

1

X

DOFETILIDE ^

CARDIOVASCULAR

1

2

DOXYCYCLINE

SKIN DISORDERS

1

3

DOXYCYCLINE TAB 150MG

INFECTION

1

3

DRONABINOL

NAUSEA AND VOMITING

1

3

LAMOTRIGINE ODT

SEIZURE DISORDERS

1

3

GUANFACINE ER

ADHD

1

3

GUANFACINE HYDROCHLORIDE

ADHD

1

3

INNOPRAN XL

CARDIOVASCULAR

3

X

MIDAZOLAM HCL

SEDATIVE/HYPNOTIC

1

3

JUBLIA

SKIN DISORDERS

2

X

LOTEMAX

EYE DISORDERS

2

X

MEFENAMIC ACID

ARTHRITIS AND PAIN

1

3

METAXALONE

PAIN

1

3

In certain circumstances, you or your prescriber can request a medical exception for a non-covered drug. To submit a request, call Aetna's Precertification Department at 1-855-582-2025, or fax a request to 1-855-330-1716. You also can mail a written request to Aetna PA, 1300 E. Campbell Rd., Richardson, TX 75081. Aetna will make a coverage determination within 24 hours of receiving the request, and notify you or your prescriber of our decision.

Click here to view the 2020 Aetna Advanced Control Formulary.

Please use the table below to identify your copayment amount:

 20-21-co-payment-breakdown.png

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