Under some plans, including plans that use an open or closed formulary, Anaspaz, Atreza, B&O,  belladonna alkaloids and opium suppositories, Colytrol, Dispas, hyoscyamine sulfate,  Levsin, Levsin SL, Marspas, NuLev, propantheline bromide, Sal-Tropine and Symax SL are subject to precertification for members greater than or equal to 65 years of age.  Aetna considers Anaspaz, Atreza, B&O, belladonna alkaloids and opium suppositories, Colytrol, Dispas, hyoscyamine sulfate, Levsin, Levsin SL, Marspas, NuLev, propantheline bromide, Sal-Tropine and Symax SL to be medically necessary for those members who meet the following precertification criteria: 

A.  Age limit:

      A.  Member has tried and failed alternative drugs that are appropriate in the elderly    
            to treat the condition. OR
      B.  Member has been stabilized on the drug for an extended period and discontinuation or    
            change in the drug might result in physical and/or mental impairment.  OR
      C.  Member is in a critical or terminal state and disruption of therapy at this point would be
            inappropriate.  AND
            Member is being monitored.  AND
            Member has no known history of emergency department visits and/or hospital admissions
            from use of the drug in the member

Anaspaz, B&O supprettes, Bentyl, Cantil, Colytrol, Levsin/Levsin SL, Marspas, NuLev, Pamine, Quarzan, Robinul/Robinul Forte and Sal-Tropine are currently Not Covered Part D drugs under the Aetna Medicare Prescription Drug Plan.* Therefore, they are excluded from coverage for members enrolled in prescription drug benefits plans that use a closed formulary, unless a medical exception is granted.  Aetna considers Anaspaz, B&O supprettes, Bentyl, Cantil, Colytrol,  Levsin/Levsin SL, Marspas, NuLev, Pamine, Quarzan, Robinul/Robinul Forte and Sal-Tropine to be medically necessary for those members who meet any of the following criteria: 

A.  A documented:

• Contraindication to one preferred generic alternative agent indicated for the member's condition OR
• Intolerance to one preferred generic alternative agent indicated for the member's condition OR
• Allergy to one preferred generic alternative agent indicated for the member's condition OR
• Failure of an adequate trial of one month of one preferred generic alternative agent indicated for the member's condition