Notes: Aetna covers injectable medications when an appropriate oral alternative drug does not exist. This coverage includes those medications intended to be self-administered. The medication must be medically necessary and appropriate to the member's needs or condition.
Experimental or investigational drugs or drugs that have not been proven safe and effective for a specific disease or approved for a mode of treatment by the Food and Drug Administration (FDA) and/or the National Institutes of Health are not covered. This provision does not exclude coverage of established “off label” uses of otherwise FDA-approved prescribed medications.
Drugs related to the treatment of non-covered services are not covered. Infertility injectable medications are covered only when required by regulation or covered by a specific benefit design. Steroids are not covered for the enhancement of performance, as this is not considered treatment of disease.
Note: Some state-to-state and plan type variations exist.
Certain classes of injectable medications are excluded from coverage under some benefit plans. Please check benefit plan descriptions for details:
Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.