MedicaidAdministrativeMedium impact
Provider Letter 2024-19: RE: SoonerSelect Cumulative Refill Too Soon Threshold for Aetna Better Health of Oklahoma
Oklahoma SoonerCare·OK·Pharmacy
Effective date
Oct 1, 2024
We identified it
Jun 20, 2026
Summary
Aetna Better Health of Oklahoma (SoonerSelect Medicaid) is implementing a new cumulative refill threshold that adds a 100-day lookback period with 90% threshold to the existing 80% refill rule for pharmacy claims. This change affects all medications except transplant drugs and is designed to prevent medication stockpiling.
Action Required
Before October 1, 2024: Billing team should notify providers that Aetna Better Health of Oklahoma members may experience pharmacy claim denials for early refills under the new cumulative threshold rules. Update patient counseling protocols to explain that refills may be limited to prevent stockpiling. Contact Aetna Better Health at 844-365-4385 for claim issues related to the new refill thresholds.