Hey RippedG, Ive been in the health and benefits business for some time now. Ive worked at a PBM Pharmacy Benefits Management company and now I am working for a company that manages all benefits for Fortune 500 companies. One of my clients uses Aetna. It is not Aetna that defines your drug coverage. More than likely itis the company you work for itself that defines your drug coverage. They or Aetna depending on if the company you work for does fully insured or self insured will work directly with a PBM like Caremark. The PBM usually has a formulary that they use and the company will put limits or exceptions to this formulary.
When I worked at the PBM the client (your company) would make us have certain limits like only allowing 6 cialis per month or having a generic mandate or having step therapy. (You have to try viagra for X amount of time before you can go to Cialis for example). Many clients would not allow steroids of any kind to be covered. Many others would only allow them or other drugs with a Prior Authorization PA. The PA can be handled many different ways. The company may have someone at the actual company look at the drug and the Dr recommendations on a case by case basis or they can have the PBM look at it and if the DR recommendations and the patient/employee meet certain predetermained criteria, the PBM would grant the PA.
So as you can see, there are many factors that determine whether a drug is covered or not and you cannot just ask if Aetna, BCBS or UHC covers a certain drug. One plan under Aetna will cover a drug where the other plan does not depending on the client and/or the PBM. The company themselves can always call or email the PBM and say John Doe needs to be covered for this drug at this dose and the PBM can put in an override/PA into the system that allows the pharmacy to process the claim and allow you the copay they decide you have to pay.
Let me know if you have any other questions. I will be glad to help.