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Aetna Pharmacy Documents and Forms
Find the documents and forms you need to request general and specialty medications.
Aetna Specialty Pharmacy offers specialized care for patients with complex chronic conditions.
Aetna Specialty Pharmacy forms
- General medication request form
(PDF) - Rheumatoid Arthritis (Rituxan) Medication Precertification Request Form (PDF)
- Repository Corticotropin (H.P Acthar Gel) Injectable Medication Precertification Request Form (PDF)
- Cetuximab (Erbitux) Injectable Medication Precertification Request Form (PDF)
- Panitumumab (Vectibix) Injectable Medication Precertification Request Form (PDF)
- Synagis® statement of medical necessity form (PDF)
- Synagis® reorder form (PDF)
- Infertility drug request form (PDF)
- IVIG therapy medication request form (PDF)
- Crohn’s / Rheumatoid arthritis / Psoriatic arthritis medication request form (PDF)
- Heparin medication request form (PDF)
- Enzyme replacement medication request form (PDF)
- EPO Medication Precertification Request Form (PDF)
- Xolair medication precertification request form (PDF)
- Viscosupplementation Medication Request Form (PDF)
Other forms
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Tools for Health Care Professionals
- Manage Claims
- Find a Doctor or Hospital
- Find a Document or Form
- Search Drugs Formularies
- Contact Aetna
