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Prior authorization* This is an important process. It is approval a person gets for care before receiving the care. This helps people know if the care is covered by a health plan. People should check with their plan to see what kind of service needs this approval. This can also be called...
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...
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Aetna considers continuation of hCG therapy medically necessary for all members (including new members) requesting reauthorization who meet all initial authorization criteria. Follitropins (e.g., follitropin alfa [Gonal-f]; follitropin beta [Follistim AQ]) Critieria for Initial Approval: Aetna consi...
Note: Aetna follows Medicare DME MAC rules with respect to the usual medically necessary quantity of supplies for positive airway pressure devices. Upon individual review, positive airway pressure devices are considered a medically necessary form of non-invasive ventilation for members with lung disease...
For Medicare criteria, see Medicare Part B Criteria.Note: Requires Precertification:Precertification of omalizumab (Xolair) is required of all Aetna participating providers and members in applicable plan designs. For precertification of omalizumab call (866) 752-7021 or fax (888) 267-3277. For ...
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 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 ...
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) ...