Clinical Policy Bulletins

Aetna Clinical Policy Bulletins (CPBs) are detailed and technical documents that explain how we make coverage decisions for members under our health benefit plans. They spell out what medical, dental, pharmacy and behavioral health technologies and services may or may not be covered.

CPBs are based on evidence from objective, credible sources:

• Scientific literature
• Technology reviews
• Consensus statements
• Expert opinions
• Guidelines from national professional health care organization
• Public health agencies

Medical Clinical Policy Bulletins
Medical CPBs state our policies on the experimental and investigational status and medical necessity of medical technologies and services.

Dental Clinical Policy Bulletins
Dental CPBs state our policies on various diagnostic, preventive, endodontic, periodontic, implant, oral surgery and orthodontic technologies and services.

Pharmacy Clinical Policy Bulletins
Pharmacy CPBs state our policies on selected prescription drugs, primarily drugs on the Formulary Exclusion list, and drugs requiring Precertification or Step-Therapy.