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Requirements for Part B drugs

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.

How step therapy works

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.

Find preferred drugs

We’ve compiled the Aetna Preferred Drug Lists below for your convenience. Just click the Medicare Advantage plan that applies. 

For your convenience, we've compiled the list of Medicare Part B Step Therapy Precertification forms.  Just click the form that applies.

 

Clinical Policy Bulletin (CPB)

Provider Fax Form

Abraxane® http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-69491-3-abraxane.pdf

Actemra®

http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68846-3-actemra.pdf
Aranesp http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68425-3-esa-agents.pdf
Botox http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68776-3-botulinum-toxins.pdf
Entyvio®  http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-69012-3-entyvio.pdf
Epogen http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68425-3-esa-agents.pdf
Evenity® http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-69492-3-evenity.pdf
Eylea®  http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-69265-3-eylea.pdf
Fulphila™ http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-69395-3-fulphila.pdf
Granix® http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-69388-3-granix.pdf
Herceptin® http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68979-3-herceptin.pdf

Herceptin® Hylecta

http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68979-3-herceptin.pdf
Ilumya™  http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-69493-3-llumya.pdf
Inflectra® http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-69299-3-inflectra.pdf
Lemtrada® http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-69256-3-lemtrada.pdf
Lucentis® http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-69275-3-lucentis.pdf

Myobloc

http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68776-3-botulinum-toxins.pdf
Neupogen® 
http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-69389-3-neupogen.pdf
Nivestym™
http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-69403-3-nivestym.pdf
Orencia®
http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68852-3-orencia.pdf

Parenteral Immunoglobulins

http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68305-3-ivig.pdf
Prolia®

http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68694-3-denosumab-xgeva.pdf
Procrit http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68425-3-esa-agents.pdf
Remicade® http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68855-3-remicade.pdf
Renflexis http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-69354-3-renflexis.pdf
Rituxan http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68535-3-rituxan.pdf
Remodulin http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-69250-3-remodulin.pdf
Stelara® http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68854-3-stelara.pdf
Tysabri® http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-69264-3-tysabri.pdf

Viscosupplementation
 
http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68744-3-visco.pdf
Xeomin http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68776-3-botulinum-toxins.pdf
Xgeva http://www.aetna.com/pharmacy-insurance/healthcare-professional/documents/medicare-gr-form-68694-3-denosumab-xgeva.pdf

 

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Health benefits and health insurance plans contain exclusions and limitations.