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

• Review your patients’ current treatment plans and the drug list changes.
  
  
• If you’re currently billing a drug to the medical benefit that’s now moving to the pharmacy benefit, you may need to issue a prescription to an in-network specialty pharmacy. Or, if you determine it’s clinically appropriate and choose to transition the patient to a preferred alternative drug option under the medical benefit, you’ll need to submit a new PA.
  
  
• If you’re currently accessing a drug through the patient’s pharmacy benefit that’s now moving to the medical benefit, you may continue to receive the drug from the in network specialty pharmacy. The specialty pharmacy will change their billing from pharmacy to medical coverage