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During precertification, a medical authorization number and confirmation of the approval of the infertility procedures will be required to bypass medical necessity review by Specialty Pharmacy Guideline Management. Note: Some plans may require medical necessity review of all infertility drugs by Aetna Spe...
Aetna partners with Novologix to offer free electronic prior authorization services for specialty drugs on Aetna’s National Precertification List. You can use this service for commercial and Medicare members for all health plans. For questions about Novologix, call 1-866-378-3791 or send them an...
The results from the model indicated that omalizumab in addition to standard therapy compared with standard therapy alone did not appear cost-effective in either the overall population or a subgroup of patients hospitalized in the year prior to enrollment, with incremental cost-effectiveness ratios of ...
Member has met all initial authorization criteria at the time of initial approval;and Member has been evaluated for evidence of amyloid-related imaging abnormalities (ARIA) on MRI prior the 5th dose (first dose of 6 mg/kg) and the 7th dose (first dose of 10 mg/kg) (seeAppendix E) ...
This Clinical Policy Bulletin addresses botulinum toxin for commercial medical plans. For Medicare criteria, seeMedicare Part B Criteria. Note: Requires Precertification: Precertification of botulinum toxin (Botox [onabotulinumtoxinA]; Daxxify [daxibotulinumtoxinA-lanm], Dysport [abobotulinumtoxinA]; ...
This Clinical Policy Bulletin addresses the following tocilizumab products for commercial medical plans. For Medicare criteria, see Medicare Part B Criteria.tocilizumab (Actemra) tocilizumab-aazq (Tyenne) tocilizumab-bavi (Tofidence)Note: Requires Precertification:...
For Medicare Part B plans, call (866) 503-0857 or fax (844) 268-7263.Hepatitis B Immune GlobulinCriteria for Initial Approval Aetna considers hepatitis B immune globulin medically necessary for members who have had contact with an individual diagnosed with hepatitis B virus (HBV). Risk groups ...
For Medicare criteria, see Medicare Part B Criteria. Note: Requires Precertification: Precertification of octreotide acetate (Sandostatin, Sandostatin LAR Depot), lanreotide (Somatuline or generic), pasireotide diaspartate (Signifor), and pasireotide pamoate (Signifor LAR) is required of all Aetna ...
This Clinical Policy Bulletin addresses infliximab for commercial medical plans. For Medicare criteria, seeMedicare Part B Criteria. Note: Requires Precertification: Precertification of an infliximab product (Avsola, Inflectra, Remicade, or Renflexis) is required of all Aetna participating providers and ...