Skip to main content

Resources for navigators and assisters

Consumers need your help to make sense of the Affordable Care Act (ACA) and their health plan options. We’re here to help you.

More coverage areas to serve more consumers

More coverage areas to serve more consumers

At this time, you can find us in select areas in the following states:

 

Your doctor may already participate with us

Your doctor may already participate with us

Provider lookup

 

Search our extensive network of primary care doctors, specialists and hospitals. Plus, local walk-in clinic* locations.

 

It's easy to check if your medicine is covered.

It's easy to check if your medicine is covered.

Medication finder
 

It's easy to find covered prescription drugs and other important pharmacy coverage details.

 

Medical exceptions

 

In certain cases, you or your prescriber can request a medical exception to the precertification, step therapy or quantity limits requirements or for a drug that’s not covered on your plan. This can be requested on or after the effective date of your coverage. Standard coverage decisions will be made within 72 hours of the initial request. You can ask for your request to be expedited. Expedited coverage decisions are made within 24 hours. We’ll then contact you or your prescriber with our decision. All medically necessary outpatient prescription drugs will be covered. If a medical exception is approved, you will only need to pay the copay after your deductible, if any, is met. This amount is based on your pharmacy plan design.

 

To submit a medical exception request for a noncovered drug, providers have these options:

 

  • Submit their request through our secure provider website on www.availity.com.
  • Call the Pharmacy Precertification Unit: Non-Specialty 1-800-294-5979 (TTY: 711) or Specialty 1-866-814-5506 (TTY: 711).
  • Fax the completed request form to: Non-Specialty 1-888-836-0730 or Specialty 1-866-249-6155.
  • Mail the completed request form to: Medical Exception to Pharmacy Prior Authorization Unit 1300 East Campbell Road Richardson, TX 75081
2024 other pharmacy plan information


Under health care reform, you can get some drugs and products with no member cost share. This means they are covered 100 percent by your plan. This list shows some common examples.

 

 

Preventive drugs and products - 2024 (PDF)

Maintenance drug list - 2024 (PDF)

 
 

Helpful resources

 

Questions? We’re here to help.

 

Get in touch with us


Your navigator support team is ready to assist you with all your questions.
 

Contact us

 

Notes

 

*FOR WALK-IN CLINIC LOCATIONS: For a complete list of participating walk-in clinics, use our provider lookup. Includes select MinuteClinic services. Not all MinuteClinic services are covered. Please consult benefit documents to confirm which services are included. Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered non-preventive MinuteClinic services at no cost-share. However, such services are covered at negotiated contract rates. This benefit is not available in all states.

For Georgia and Texas: Includes select walk-in clinic services. Not all walk-in clinic services are covered. Please consult benefit documents to confirm which services are included. Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered non-preventive walk-in clinic services at no cost-share.

Legal notices

Health plans are offered or underwritten or administered by Aetna Health of California Inc., Aetna Health Inc. (Florida), Aetna Health Inc. (Georgia), Aetna Life Insurance Company, Aetna Health of Utah Inc., Aetna Health Inc. (Pennsylvania), or Aetna Health Inc. (Texas) (Aetna). Aetna and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies.

Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Information is accurate as of the production date; however, it is subject to change.

Health benefits and health insurance plans contain exclusions and limitations.