Changes to medical plan drug lists
On January 1, 2027, we’ll update our medical plan drug lists. These changes support our commitment to high-quality, cost effective health care. Some of your patients may already be taking these drugs. If your patients have an existing authorization in place for the impacted drugs, this change won’t affect them until their current authorization’s expiration date.
Starting on November 1, 2026, we’ll notify your impacted patients of these changes. We’ll suggest that they talk to you about changing to a preferred alternative drug if appropriate.
You’ll be able to view the changes online as early as November 1, 2026. They’ll be posted on our Precertification lists and medical preferred drug information page.
No action required for current prior authorizations (PA)
If you’re currently managing patients with a PA for a drug that moved to non-preferred status, you don’t need to initiate the PA process again. Their current PA will remain in place until its expiration date.
This information doesn’t apply to Aetna Health Exchange and federal employee plans.
On January 1, 2027, we’ll update the drugs covered on the Combined Benefit Management drug list. This list applies to certain specialty medications for our commercial fully insured members with Aetna® medical and pharmacy benefit plans, subject to applicable state laws.
With these updates, certain drugs may move from a member’s medical benefit to their pharmacy benefit, or vice versa.
These updates support our commitment to high-quality, cost effective health care.
What’s behind the updates
The updates focus on drugs known as provider-administered specialty drugs.
Your patients may see lower costs for those drugs and may have the opportunity to enroll in copay assistance programs. Some of your patients may already be taking these drugs.
Supporting you and your patients
We’ll notify patients affected by these changes. Beginning November 1, 2026, you can access these changes on our Precertification lists and medical preferred drug information page.
No action required for existing prior authorizations (PA)
We’re committed to smooth transitions for you and your patients. PAs for members currently on an affected drug will remain in place until the current expiration. We'll proactively load a PA on the new benefit with the same termination date as the member’s existing PA.
Your next steps
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