When we require precertification Precertification occurs before inpatient admissions and select ambulatory procedures and services. Precertification applies to: Procedures and services on the Aetna Participating Provider Precertification List Procedures and services on the Aetna Behavioral Health Precertification...
Note: Requires Precertification: Precertification of botulinum toxin (Botox [onabotulinumtoxinA]; Daxxify [daxibotulinumtoxinA-lanm], Dysport [abobotulinumtoxinA]; Myobloc [rimabotulinumtoxinB]; and Xeomin [incobotulinumtoxinA]) is required of all Aetna participating providers and members in applica...
Note: Requires Precertification: Precertification of aflibercept [(Eylea), (Eylea HD)], aflibercept-jbvf (Yesafili), aflibercept-mrbb (Ahzantive), aflibercept-yszy (Opuviz), brolucizumab-dbll (Beovu), faricimab-svoa (Vabysmo), ranibizumab (Lucentis), ranibizumab (Susvimo), ranibizumab-eqr...
Note: Requires Precertification: Precertification of Cetrotide (cetrorelix acetate), ganirelix acetate, Follistim AQ (follitropin beta), Gonal-F (follitropin alfa), Menopur (menotropins), Novarel (chorionic gonadotropin), Pregnyl (chorionic gonadotropin), Ovidrel (choriogonadotropin alfa), and chorion...
Precertification of nivolumab (Opdivo), nivolumab and hyaluronidase-nvhy (Opdivo Qvantig), and nivolumab and relatlimab-rmbw (Opdualag) is required of all Aetna participating providers and members in applicable plan designs. For precertification of nivolumab (Opdivo), nivolumab and hyaluronidase-nv...
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 ...
For precertification of omalizumab call (866) 752-7021 or fax (888) 267-3277. For Statement of Medical Necessity (SMN) precertification forms, see Specialty Pharmacy Precertification.Note: Site of Care Utilization Management Policy applies for omalizumab (Xolair). For information on site of ...
Precertification of bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta, and bendamustine) is required of all Aetna participating providers and members in applicable plan designs. For precertification of bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta, and bendamustine), call (866) 752-7021...
Precertification of long-acting granulocyte colony stimulating factor (G-CSF) products [Fulphila (pegfilgrastim-jmdp); Fylnetra (pegfilgrastim-pbbk); Neulasta (pegfilgrastim); Nyvepria (pegfilgrastim-apgf); Rolvedon (eflapegrastim-xnst), Ryzneuta (efbemalenograstim alfa-vuxw), Stimufend (pegfil...
For precertification of teprotumumab-trbw (Tepezza), call (866) 752-7021 or fax (888) 267-3277. For Statement of Medical Necessity (SMN) precertification forms, see Specialty Pharmacy Precertification. Note: Site of Care Utilization Management Policy applies for teprotumumab-trbw (Tepezza)....