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:

1. Anabolic steroids when used for performance enhancement (also see CPB 0528 - Androgens and Anabolic Steroids)
2. Contraceptive injectable medications.** (also see CPB 0510 - Progestins)
3. Immunizations for travel (also see CPB 0473 - Vaccines for Travel)
4. Infertility injectable medications* (also see CPB 0327 - Infertility)

* Exception: Infertility injectable medications are covered only when required by regulation or covered by a specific benefit design.

**Contraceptive injectable medications are covered under plans with the contraceptives rider or under plans with a contraceptives benefit.