Under Medicare Advantage plans, some medically administered Part B drugs, like injectables or biologics, may have special requirements or coverage limits. We’ll help you find the information you need.
One of these special requirements or coverage limits is known as step therapy, where we require a trial of a preferred drug to treat a medical condition before covering another non-preferred drug.
Here’s an example:
If Drug A and Drug B both treat a medical condition, we may prefer Drug A and require a trial of it first. If Drug A does not work, we’ll then cover Drug B. The listed preferred products should be used first.
Note: The step therapy requirement does not apply to patients who’ve already received treatment with the non-preferred drug within the past 365 days.
We’ve compiled the Aetna Preferred Drug Lists below for your convenience. Just click the Medicare Advantage plan that applies.
Clinical Policy Bulletin (CPB)
Provider Fax Form
|Abraxane®||Medicare GR form 69491-3 Abraxane (PDF)|
|Actemra®||Medicare GR form 68846-3 Actemra (PDF)|
|Avsola®||Medicare GR form 69545-3 Avsola (PDF)|
|Beovu®||Medicare GR form 69528 Beovu (PDF)|
|Botox®||Medicare GR form 68776-3 Botox (PDF)|
|Dysport®||Medicare GR form 68776-3 Dysport (PDF)|
|Entyvio®||Medicare GR form 69012-3 Entyvio (PDF)|
|Epogen®||Medicare GR form 68425-3 Epogen (PDF)|
|Evenity®||Medicare GR form 69492-3 Evenity (PDF)|
|Eylea®||Medicare GR form 69265-3 Eylea (PDF)|
|Flolan®||Medicare GR form 69250-3 Flolan (PDF)|
|Granix®||Medicare GR form 69388-3 Granix (PDF)|
|Herzuma®||Medicare GR form 69553 Herzuma (PDF)|
|Ilumya™||Medicare GR form 69493-3 Ilumya (PDF)|
|Inflectra®||Medicare GR form 69299-3 Inflectra (PDF)|
|Lemtrada®||Medicare GR form 69256-3 Lemtrada (PDF)|
|Lucentis®||Medicare GR form 69275-3 Lucentis (PDF)|
|Myobloc®||Medicare GR form 68776-3 Myobloc (PDF)|
||Medicare GR form 69389-3 Neupogen (PDF)|
||Medicare GR form 69403-3 Nivestym (PDF)|
|Nyvepria™||Medicare GR form 69409-3 Nyvepria (PDF)|
|Ogivri®||Medicare GR form 69538 Ogivri (PDF)|
|Ontruzant®||Medicare GR form 69567 Ontruzant (PDF)|
||Medicare GR form 68852-3 Orencia (PDF)|
|Parenteral Immunoglobulins||Medicare GR form 68305-3 Parental Immunoglobulins (PDF)|
|Procrit®||Medicare GR form 68425-3 Procrit (PDF)|
|Remicade®||Medicare GR form 68855-3 Remicade (PDF)|
|Remodulin®||Medicare GR form 69354-3 Remodulin (PDF)|
|Renflexis®||Medicare GR form 69354-3 Renflexis (PDF)|
|Rituxan®||Medicare GR form 68535-3 Rituxan (PDF)|
|Simponi Aria®||Medicare GR form 69253-3 Simponi Aria (PDF)|
|Stelara®||Medicare GR form 68854-3 Stelara (PDF)|
|Truxima®||Medicare GR form 68535-3 Truxima (PDF)|
|Tysabri®||Medicare GR form 69264-3 Tysabri (PDF)|
|Viscosupplementation||Medicare GR form 68744-3 Viscosupplementation (PDF)|
|Udenyca®||Medicare GR form 69409-3 Udenyca (PDF)|
|Veletri®||Medicare GR form 69250-3 Veletri (PDF)|
|Xgeva®||Medicare GR form 68694-3 Xgeva (PDF)|
|Ziextenzo®||Medicare GR form 69409-3 Ziextenzo (PDF)|
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Health benefits and health insurance plans contain exclusions and limitations.
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Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Do you want to continue?