Aetna offers health insurance, as well as dental, vision and other plans, to meet the needs of individuals and families, employers, health care providers and insurance agents/brokers. The path to healthy starts here.
An example would be the claim your doctor sends to your health plan for an office visit. It is also a request for payment under a disability or life insurance plan. Closed formulary A formulary is a list of prescription drugs the health plan covers. If the plan has a closed formulary, ...
If there’s an economic incentive for the pharmacy provider to sell a more expensive drug, the health plan becomes a vehicle to do so. The health plan essentially dictates the choice drugs, down to the brand, with what is known as a formulary list. Consumers pick up an expensive ...
Non-Formulary Prior Authorization guideline for Cystic Fibrosis MedicationsTobi Podhaler
PHARMACY PRIOR AUTHORIZATION Clinical Guideline – BOTULINUM TOXINS Botox® (onabotulinumtoxinA) Myobloc® (rimabotulinumtoxinB) Dysport® (abobotulinumtoxinA) Xeomin® (incobotulinumtoxinA)Additional criteria for Neurogenic bladder: * Request is for Botox * Trial and failure of 2 formulary ...
Note:See Pharmacy Clinical Policy Bulletins for: Vyleesi (bremelanotide injection) for the treatment of pre-menopausal women with acquired, generalized hypoactive sexual desire disorder (HSDD), and for Osphena (ospemiphene tablets) for severe vaginal dryness and dyspareunia due to menopause. ...
Note: Many Aetna benefit plans specifically exclude coverage of weight reduction medications under the pharmacy benefit and/or under the health benefits plan. The medical necessity criteria set forth below do not apply to health plans that specifically exclude services and supplies for or related to ...
For Statement of Medical Necessity (SMN) precertification forms, see Specialty Pharmacy Precertification. Prescriber Specialties This medication must be prescribed by or in consultation with one of the following: Rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, ankylosing spondylitis, or ...
Footnote1*Note: Self-administered prescription medications are covered under the pharmacy benefit. Formulary restrictions may apply. Please check plan benefit description for details. Psychotherapy (if member also exhibits anxiety and/or depression) Psychotherapeutic interventions are covered under the member...
See alsoAetna Non-Medicare Prescription Drug Plan Specialty Pharmacy Clinical Policy Bulletins. Dosage and Administration For dosing recommendations, see prescribing information for individual products. Experimental, Investigational, or Unproven Aetna considers the use of IVIG and SCIG experimental, investigation...