Aetna ppo formulary medication list: free download. On-line document store on 5y1.org

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Jun 21, 2019 · Mental Health Formulary . Listed on the following pages are mental health drugs which are carved out of the Managed Care Organization (MCO) pharmacy benefit. Some of these drugs are subject to prior authorization requirements of the Preferred Drug List.
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code list. 4/16/03 b.1. other_payer_id other_payer_name. i0288 advance paradigm. i1413 advanced pcs. i1606 aetna pharmacy. i0340 aetna pharmacy management. i1414 aetna services inc. i1647 aetna us healthcare. at531 alliance ppo mapst. i0255 american community mutual ins. i0411 associate prescription service. bb24d bc bs of md fed employees ...
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Aetna PPO Aetna Global PPO. Aetna Inc. Aetna Global Benefits. P.O. Box 981106 P.O. Box 30258. El Paso, TX 79998-1106 Tampa, FL 33630-3258 USA. Recourse if a claim is denied. If Aetna denies a claim in whole or in part, the subscriber will receive a written notice from Aetna.
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Drug List (Formulary) – A list of prescription drugs, medicines, medications and supplies approved by Humana, which identifies drugs as Level 1, 2, or 3. Generic Medication – A medication that is manufactured, distributed and available from several pharmaceutical manufacturers …
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Aetna PPO/POS II Aetna International PPO. Aetna Inc. Aetna International® P.O. Box 981106 P.O. Box 981543. El Paso, TX 79998-1106 El Paso, TX 79998-1543 USA Recourse if a claim is denied. If Aetna denies a claim in whole or in part, the subscriber will receive a written notice from Aetna.
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You pay the following: Generic: $8.00 copay $20.00 copay $16.00 copay $65.00 copay Formulary $35.00 copay $87.50 copay $70.00 copay $65.00 copay Non-Formulary $55.00 copay $137.50 copay $110.00 copay $65.00 copay Under the Base Plan and the Buy Up Plan, outpatient prescription drugs do not accumulate toward the Plan’s Deductibles
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Any Brand Name Prescription Drugs that do not appear on the list of Preferred Drugs. These drugs are considered Tier 3 drugs. Preferred . Brand-Name Prescription . Drug: A list of Brand Name Prescription Drugs that has been developed by a Pharmacy and Therapeutics Committee comprised of Physicians, Pharmacists and other health care professionals.
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Aetna ppo formulary medication list