CurrentAetnaPolicy N/A

Reduced copay prescription drug coverage for Massachusetts chronic conditions

Describes reduced copay amounts for certain prescription drugs for Aetna members in Massachusetts with specified chronic conditions, effective starting July 1, 2025 and extending through 2026 with annual updates.

Policy Summary

PayerAetna

PolicyReduced copay prescription drug coverage for Massachusetts chronic conditions

Policy CodePolicy N/A

Change TypeNo material change

Effective DateStarting July 1, 2025

Next Review DateN/A

Key ActionMembers with qualifying chronic conditions in Massachusetts may receive certain prescription drugs at reduced copays; contact Member Services for questions.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

$0copay level for listed generic drugs

$25copay level for listed brand-name and insulin drugs

Through 2026duration of lower-cost coverage

3 chronic condition categoriesexamples listed

Reduced Copay Coverage Criteria

Reduced copay coverage criteria

Covered when ALL of the following are met:

Member is an Aetna member in Massachusetts.

Member has a qualifying chronic condition (examples listed: asthma, diabetes, atrial fibrillation, coronary artery disease).

ALL of the following

$0 copay — generic drugs
- ALBUTEROL (generic) — $0 copay
- SOTALOL (generic) — $0 copay

Policy Summary

PayerAetna

PolicyReduced copay prescription drug coverage for Massachusetts chronic conditions

Policy CodePolicy N/A

Change TypeNo material change

Effective DateStarting July 1, 2025

Next Review DateN/A

Key ActionMembers with qualifying chronic conditions in Massachusetts may receive certain prescription drugs at reduced copays; contact Member Services for questions.

SourceLink

On This Page

Drug Lists and Effective Period

Generic drugs with $0 copayNDCCovered

	ALBUTEROL — $0 copay
	SOTALOL — $0 copay
	METOPROLOL/HYDROCHLOROTHIAZIDE — $0 copay

Brand-name and insulin drugs with $25 copayNDCCovered

	BREO ELLIPTA — $25 copay
	ELIQUIS — $25 copay
	BRILINTA — $25 copay
	NOVOLIN 70/30 FLEXPEN — $25 copay
	NOVOLIN N FLEXPEN — $25 copay
	LANTUS SOLOSTAR — $25 copay
	NOVOLOG — $25 copay
	NOVOLIN R — $25 copay
	TRESIBA FLEXTOUCH — $25 copay

Effective period

Effective start dateLower costs apply starting July 1, 2025

DurationCoverage of reduced copays continues through 2026

Update cadenceReduced-cost list will be updated annually thereafter

Member supportContact Member Services (number on back of ID card) for questions or assistance

Member Assistance and Provider Guidance

Documentation Required

Member assistance and scope

Starting July 1, 2025, Massachusetts law provides lower copays for certain prescription drugs for members with qualifying chronic conditions (examples: asthma, diabetes, and two specified heart problems). For questions or help confirming member eligibility or coverage, contact Member Services using the number on the back of the member’s ID card.

OpenPayer

Reduced copay prescription drug coverage for Massachusetts chronic conditions

Reduced Copay Coverage Criteria

Drug Lists and Effective Period

Member Assistance and Provider Guidance

Qualifying Chronic Conditions