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Changes to our National Precertification List (NPL)


Effective September 1, 2022, the following medical precertification changes apply to commercial and Medicare.


Please note that the following medications are usually self-administered and therefore will be excluded from the medical benefit unless an exception is granted. For Medicare, coverage determinations will still follow all Centers for Medicare & Medicaid Services (CMS) National and Local Coverage Determinations. Precertification may still be required through the pharmacy benefit for commercial plans and the Part D drug benefit for Medicare plans.


We will no longer require medical precertification for the following drugs. Precertification may still be required through pharmacy plans.


Cardiovascular PCSK9 inhibitors


  • Praluent® (alirocumab)
  • Repatha® (evolocumab)


Growth hormones


  • Genotropin® (somatropin)
  • Humatrope® (somatropin)
  • Increlex® (mecasermin)
  • Norditropin®(somatropin)
  • Omnitrope® (somatropin)
  • Saizen® (somatropin)
  • Serostim® (somatropin)
  • Zomacton® (somatropin [rDNA origin])
  • Zorbtive® (somatropin)


Immunologic agents


  • Enbrel® (etanercept)
  • Humira® (adalimumab)
  • Kevzara® (sarilumab)
  • Kineret® (anakinra)
  • Siliq® (brodalumab)
  • Simponi® (golimumab)
  • Taltz® (ixekizumab)


Multiple sclerosis (MS) drugs


  • Betaseron® (interferon beta-1b)
  • Copaxone® (glatiramer acetate)
  • Extavia® (interferon beta-1b)
  • Glatopa® (glatiramer acetate injection)
  • Plegridy® (peginterferon beta-1a)
  • Rebif® (interferon beta-1a)


Osteoporosis drugs


  • Tymlos® (abaloparatide)


Other drugs


  • Dupixent® (dupilumab)


Effective September 1, 2022, the following medications will no longer require medical precertification for commercial plans. Medical precertification will still be required for the drugs listed below for Medicare plans.


Growth hormones


  • Skytrofa™ (lonapegsomatropin-tcgd)
  • Sogroya® (somapacitan-beco)


Immunologic agents


  • Actemra® SC (tocilizumab)
  • Cimzia® (certolizumab pegol)
  • Cosentyx® (secukinumab)
  • Enspryng® (satralizumab)
  • Ilumya® (tildrakizumab)
  • Orencia SQ® (abatacept)
  • Skyrizi® (risankizumab-rzaa)
  • Stelara® (ustekinumab)
  • Tremfya® (guselkumab)


Multiple sclerosis (MS) drugs


  • Avonex® (interferon beta-1a)
  • Kesimpta® (ofatumumab)


Osteoporosis drugs


  • Bonsity™ (teriparatide)
  • Evenity® (romosozumab-aqqg)
  • Forteo® (teriparatide)
  • Miacalcin® (calcitonin)
  • Prolia® (denosumab)


Submitting precertification requests



Be sure to submit precertification requests at least two weeks in advance. To save time, request precertification online. Doing so is fast, secure and simple.


You can submit most requests online through our Availity provider portal.* Or you can use your practice’s Electronic Medical Record (EMR) system if it’s set up for electronic precertification requests. Use our “Search by CPT code” search function on our precertification lists page to find out if the code requires precertification. Learn more about precertification.


Are you asking for precertification on a specialty drug for a commercial or Medicare member? Then submit your request through Novologix®, also available on Availity.


Not registered for Availity? Go to Availity to register and learn more.


*Availity is available only to U.S. providers and its territories.

Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

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