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Aetna Medicare 2014 Formularies
Top Medicare Part D Drugs
Top 100 Drug List (by rank) with Pharmacy Pricing†
This is a list of 100 drugs commonly used by seniors. Below are the copay tiers for each of the Aetna Medicare formularies
and drug price as of October 2013. Drug price is based on Medicare Plan Finder data and is the average price of four
national chains based upon default strength and dosing. Actual costs may differ. This list is for il ustrative purposes only and
does not display al covered drugs. For a complete listing of drugs, members should refer to the comprehensive formulary
guide.
Drug Price†
Quantity per
(Copay for Tier 1,
Drug Name
Strength
SaverPlus
Enhanced
Coinsurance for
Formulary1
Formulary2
Formulary3
Tiers 2 and 3)
atorvastatin tab (generic LIPITOR) 11 metoprolol er (generic TOPROL XL) 13 potassium chloride cr, er, sr tab 19 NEXIUM cap
21 triamterene and hydrochlorothiazide cap 22 lansoprazole (generic PREVACID) 24 SPIRIVA
25 escitalopram (generic LEXAPRO) 27 DIOVAN
30 SYNTHROID
For Agent Use Only. Not to be shared with Medicare beneficiaries.
Drug Price†
Drug Name
Strength
Quantity per
(Copay for Tier 1,
SaverPlus
Enhanced
Coinsurance for
Formulary1
Formulary2
Formulary3
Tiers 2 and 3)
31 SYMBICORT
160 mcg/4.5 mcg; 1
32 PROVENTIL HFA
1 inhaler
33 donepezil tab (generic ARICEPT) 37 pantoprazole (generic PROTONIX) 43 risperidone tab (generic RISPERDAL) 44 ADVAIR
250 mcg/50 mcg; 1
48 VYTORIN
10 mg/20 mg
49 AVANDIA
50 sertraline tab (generic ZOLOFT ) 51 tamsulosin cap (generic FLOMAX) 53 pioglitazone tab (generic ACTOS) 54 amlodipine-benazepril (generic LOTREL) 61 montelukast (generic SINGULAIR) 64 lisinopril and hydrochlorothiazide 65 CELEBREX
66 LANTUS
68 PREMARIN tab
For Agent Use Only. Not to be shared with Medicare beneficiaries.
Drug Price†
Drug Name
Strength
Quantity per
(Copay for Tier 1,
SaverPlus
Enhanced
Coinsurance for
Formulary1
Formulary2
Formulary3
Tiers 2 and 3)
71 valsartan-hydrochlorothiazide (generic 73 LEVEMIR
75 levofloxacin (generic LEVAQUIN) 77 CRESTOR
82 NAMENDA
83 venlafaxine ER (generic EFFEXOR XR) 84 DETROL LA
91 JANUVIA
96 COMBIVENT
1 inhaler
99 SEROQUEL XR
This is a partial listing of drugs available on Aetna Medicare 2014 formularies as of October, 2013. For a complete and current listing, review the
Comprehensive Formulary Drug Lists available at www.aetnamedicare.com.
Tier placement for Aetna / CVS pharmacy Prescription Drug Plan (PDP)
Tier placement for Aetna Medicare Advantage Prescription Drug (MAPD) plans
Tier placement for Aetna Medicare Advantage Prescription Drug (MAPD) plans and Aetna Medicare Rx Premier (PDP)
Average price of the four national chains (Walmart, CVS, Walgreens, Rite Aid) is based on Medicare Plan Finder default strength and
dosing data. The member's actual cost-share may differ from the prices shown based upon pharmacy used to fil a prescription, as well
as strength and dosing.
NC Drug not covered on this formulary
For Agent Use Only. Not to be shared with Medicare beneficiaries.

Source: http://www.maforagents.com/carriers/aetna/Marketing_Enrollment/2014%20Top%20100%20Drugs%20-%20By%20Rank.pdf