Exception: Requests for drugs administered by a healthcare professional that will be billed to the medical plan, call 1-866-503-0857 or fax applicable request forms to 1-888-267-3277. Policy: Note: The provision of physician samples does not guarantee coverage under the provisions of the pharmacy benefit.1-866-503-0857 . For other lines of business: Please use other form. Note: Nyvepria, Udenyca, and Ziextenzo are non-preferred. Neulasta/Neulasta Onpro and Fulphila are preferred. (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date . Continuation of therapy: Date of last treatmentFulvestrant Injection: learn about side effects, dosage, special precautions, and more on MedlinePlus Fulvestrant injection is used alone or in combination with ribociclib (Kisqali...This call could be a scam. There are several versions of these that I have heard of: Generally there is a representation that the person calling is an official or owed money and that there is a court case that can be dealt with immediately with a credit card payment. These can be ignored. If there is another call demand to know the full name of the person; the return telephone number and ...: 1-866-503-0857 . FAX: 1-844-268-7263 . For other lines of business: Please use other form. Note: Aralast NP, Glassia and Zemaira are non-preferred. The preferred product is Prolastin-C. (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date . Continuation of therapy: Date of ...1-866-503-0857 . For other lines of business: Please use other form. Note: Inflectra is non-preferred. Preferred products vary based on indication. See section G below. (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date / / Continuation of therapy: Date of last treatment / /Policy: Precertification Criteria; Under some plans, including plans that use an open or closed formulary, Benlysta is subject to precertification. If precertification requirements apply Aetna considers Benlysta to be medically necessary for those members who meet ALL of the following precertification criteria:503 Sunport Lane, Orlando, FL 32809 Phone: 1-866-503-0857 FAX: 1-888-267-3277 For Medicare Advantage Part B: FAX: 1-844-268-7263 Patient First Name Patient Last Name Patient Phone Patient DOB G. CLINICAL INFORMATION - Required clinical information must be completed in its entirety for all precertification requests.1-866-752-7021 FAX: 1-888-267-3277 For Medicare Advantage Part B: Phone: 1-866-503-0857 FAX: 1-844-268-7263 Patient First Name . Patient Last Name . Patient Phone . Patient DOB . G. CLINICAL INFORMATION (continued) - Required clinical information must be completed in its entirety for all precertification requests.: 1-866-503-0857 For other lines of business: Please use other form Note: Cinqair is non-preferred. The preferred products are Nucala and Xolair. G. CLINICAL INFORMATION (continued) - Required clinical information must be completed in its entirety for all precertification requests. / / Patient First Name . Patient Last Name . Patient Phone160 Fountain Pkwy N. Suite 200. St. Petersburg, FL 33716-1205. Interested in ordering products from CCS? See how easy it is. Learn More. Contact CCS customer support via email at [email protected] or by phone at 1-888-MEDICAL. Hours of operation: 8:00a.m. - 6:00p.m. ET, Monday-Friday.Right knee. Left knee. Aetna Precertification Notification 503 Sunport Lane, Orlando, FL 32809 Phone: 1-866-503-0857 FAX: 1-888-267-3277 both knees. If ASRx is dispensing, ship to: Dispensing Provider: Date of last treatment: Doctor’s office Patient Other: Aetna Specialty Pharmacy® or. Other: Phone: Fax:Free essays, homework help, flashcards, research papers, book reports, term papers, history, science, politicsDrug: Cosentyx® (secukinumab) Note: Precertification review for this medication is handled by Aetna Pharmacy Management Precertification at 1-855-240-0535 or fax applicable request forms to 1-877-269-9916. Exception: Requests for drugs administered by a healthcare professional that will be billed to the medical plan, call 1-866-503-0857 or fax applicable request forms to 1-888-267-3277Page 2 of 3. (All fields must be completed and legible for precertification review) Aetna Precertification Notification. Phone: 1-855-240-0535. FAX: 1-877-269-9916. For Medicare Advantage Part B: Phone: 1-866-503-0857 FAX: 1-844-268-7263. Patient First Name.503 Sunport Lane, Orlando, FL 32809 Phone: 1-866-503-0857 FAX: 1-888-267-3277 For Medicare Advantage Part B: FAX: 1-844-268-7263 Patient First Name . Patient Last Name . Patient Phone . Patient DOB . G. CLINICAL INFORMATION (continued) – Required clinical information must be completed in its entirety for all precertification requests.1-866-503-0857 . For other lines of business: Please use other form. Note: Tremfya is non-preferred. Preferred products vary based on (All fields must be completed and legible for precertification review.) indication. See section G below. Please indicate: Start of treatment: Start date / / Continuation of therapy: Date of last treatment / /Page 2 of 2. (All fields must be completed and legible for precertification review.) Patient First Name. Patient Last Name. Patient Phone. For Medicare Advantage Part B: FAX: 1-844-268-7263 PHONE: 1-866-503-0857. For other lines of business: please use other form. Note: Simponi Aria is preferred for MA plans and non-preferred for MAPD plans.866-782-2779: Mental health and Substance abuse: Refer to the back side of the member ID card: National Medical Excellence Program: 877-212-8811: Aetna Student Health Aetna Workers Comp Access Meritain Health: Refer Member Identification card: Aetna Signature Administrators: 800-238-6288: CoverMyMeds: 866-503-0857 (Preauthorization) 866-452 ...1-866-752-7021. FAX: 1-888-267-3277 . For Medicare Advantage Part B: Phone: 1-866-503-0857. FAX: 1-844-268-7263 (All fields must be completed and legible for Precertification Review.) Please indicate: Start of treatment: Start date / / Continuation of therapy: Date of last treatment / / Precertification Requested By: Phone: Fax: A. PATIENT ...PHONE: 1-866-503-0857 (TTY: 711) For other lines of business: Please use other form. Note: Beovu is non-preferred. The preferred products are bevacizumab (Avastin) first followed by Byooviz. Avastin (C9257) and bevacizumab biosimilars do not require precertification for ophthalmic use. G. CLINICAL INFORMATION (continued)1-866-752-7021 . FAX: 1-888-267-3277 . For Medicare Advantage Part B: Phone: 1-866-503-0857 . FAX: 1-844-268-7263 (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date / / Continuation of therapy: Date of last treatment / / Precertification Requested By: Phone: Fax: A. PATIENT ...1-866-503-0857 . For other lines of business: Please use other form. Note: Inflectra is non-preferred. Preferred products vary based on indication. See section G below. (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date / / Continuation of therapy: Date of last treatment / /PHONE: 1-866-503-0857 . For other lines of business: Please use other form . Note: Trelstar is non-preferred. The preferred product is Eligard. Firmagon is also a preferred product. (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date. Continuation of therapy, Date of last treatmentMEDICARE FORM. Tremfya® (guselkumab) Medication Precertification Request. Page 2 of 2. (All fields must be completed and legible for precertification review.) For Medicare Advantage Part B: FAX: 1-844-268-7263. PHONE: 1-866-503-0857. For other lines of business: Please use other form.Specialty Medication Precertification Request - … GR-69374 (2-18)Page 1 of 2 Specialty Medication Precertification Request Aetna Precertification Notification503 Sunport Lane, Orlando, FL 32809 Phone: 1-866-503-0857 FAX: 1-888-267-3277 For Medicare Advantage Part B:FAX: 1-844-268-7263 (All fields must be completed and legible for Precertification Review.)Drug: Humira® (adalimumab inj kit) Note: Precertification review for this medication is handled by Aetna Pharmacy Management Precertification at 1-855-240-0535 or fax applicable request forms to 1-877-269-9916. Exception: Requests for drugs administered by a healthcare professional that will be billed to the medical plan, call 1-866-503-0857 or fax applicable request forms to 1-888-267-3277.1-866-752-7021 acetate for depot suspension) FAX: 1-888-267-3277 Medication Precertification Request For Medicare Advantage Part B: Phone: 1-866-503-0857 Page 2 of 2 FAX: 1-844-268-7263 (All fields must be completed and legible for Precertification Review) Patient First Name . Patient Last Name . Patient Phone . Patient DOB . H. ACKNOWLEDGEMENTRemicade® (infliximab) Injectable Medication Precertification Request. Page 1 of 5. (All fields must be completed and legible for precertification review.) FAX: 1-844-268-7263. PHONE: 1-866-503-0857. For other lines of business: Please use other form. Note: Remicade is preferred for MA plans. Preferred status for.De therapeuten van Praktijk de Liefde helpen jullie stap voor stap verder in dit proces. Met relatietherapie doorbreken jullie de oude patronen, ontwikkelen jullie meer begrip voor …1 // // // Soliris (eculizumab) Injectable Medication precertification request Aetna precertification Notification503 Sunport Lane, Orlando, FL 32809 Phone: 1-866-503-0857 FAX: 1-888-267-3277 For Medicare Advantage Part B: FAX: 1-844-268-7263 Page 1 of 3(All fields must be completed and legible for precertification Review.)Diabetic Testing Supplies Prior Authorization Request Form Ph: (866) 503-0857 Fax: (877) 269-9916 . MEMBER INFORMATION Member name . Member ID . Member Address, City, State, ZIPPHONE: 1-866-503-0857 . For other lines of business: Please use other form. Note: Remicade is preferred for MA plans. Preferred status for MAPD plans varies based on indication. See section G below. (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date / / Continuation of therapy:503 Sunport Lane, Orlando, FL 32809 . Phone: 1-866-752-7021 . FAX: 1-888-267-3277 . For Medicare Advantage Part B: Phone: 1-866-503-0857 . FAX: 1-844-268-7263 (All fields must be completed and legible for precertification review) Please indicate: Start of treatment: Start date: / / Continuation of therapy: Date of last treatment / /Free essays, homework help, flashcards, research papers, book reports, term papers, history, science, politicsRepository (H.P. Gel) Aetna Precertification Notification 503 Sunport Lane Orlando, FL 32809 Phone: 1-866-503-0857 FAX: 1-888-267-3277 Medication Precertification Request (All fields must be completed. How It Works. Open form follow the instructions. Easily sign the form with your fingerRemicade® (infliximab) Note: Precertification review for these medications is handled through Aetna Specialty Precert Unit at 1-866-503-0857. Site of Care Utilization Management Policy applies. For information on site of service for Remicade, see Utilization Management Policy on Site of Care for Specialty Drug Infusions at https://www.aetna ...Alirocumab (PraluentTM) Injectable Medication Precertification Request. Aetna Precertification Notification 503 Sunport Lane, Orlando, FL 32809 Phone: 1-866-503-0857. Page 1 of 2. FAX: 1-888-267-3277. (All fields must be completed and legible for precertification review) For Medicare Advantage Part B: FAX: 1-844-268-7263.Phone: 1-866-752-7021 . Medication Precertification Request . FAX: 1-888-267-3277 . Page 1 of 2 For Medicare Advantage Part B: (All fields must be completed and legible for precertification review.) Phone: 1-866-503-0857 FAX: 1-844-268-7263 . Patient First Name . Patient Last Name . Patient Phone . Patient DOB1-866-503-0857 . For other lines of business: Please use other form. Note: Inflectra is non-preferred. Preferred products vary based on indication. See section G below. (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date / / Continuation of therapy: Date of last treatment / /866 503 0857. Get the up-to-date GR 68722 Medication Precertification Form - Aetna 2024 now Get Form. 4.4 out of 5. 215 votes. DocHub Reviews. 44 reviews. DocHub Reviews. 23 ratings. 15,005. 10,000,000+ 303. 100,000+ users . Here's how it works. 01. Edit your form online.(), Ado- (Kayla) and Pertuzumab (Peseta) Injectable Medication Recertification Request Aetna Recertification Notification 503 Support Lane, Orlando, FL 32809 Phone: 1-866-503-0857 FAX: 1-888-267-3277 We are not affiliated with any brand or entity on this formTo initiate precertification or inquire about pending precertification, call an Aetna representative toll free at 1-866-503-0857. Next-day delivery Complete orders received before 3 p.m. ET are scheduled for next-day delivery.Aetna Precertification Notification Phone: 1-866-752-7021 FAX: 1-888-267-3277 For Medicare Advantage Part B: Phone: 1-866-503-0857 FAX: 1-844-268-7263 (All fields must be completed and legible for Precertification Review.) Please indicate: Start of treatment: Start date. Continuation of therapy: Date of last treatment. Precertification...Precertification review for this medication is handled through Aetna Specialty Precert Unit at 1-866-503-0857 Refer to Medical CPB #0807 Eculizumab (Soliris) Site of Care Utilization Management Policy applies. For information on site of service for Soliris, ...Drug. Remicade® (infliximab) Note: Precertification review for these medications is handled through Aetna Specialty Precert Unit at 1-866-503-0857. For Oral Corticosteroid Clinical policy click here. Policy: Note: The provision of physician samples does not guarantee coverage under the provisions of the pharmacy benefit.Drug: Humira® (adalimumab inj kit) Note: Precertification review for this medication is handled by Aetna Pharmacy Management Precertification at 1-855-240-0535 or fax applicable request forms to 1-877-269-9916. Exception: Requests for drugs administered by a healthcare professional that will be billed to the medical plan, call 1-866-503-0857 or fax applicable request forms to 1-888-267-3277.Phone: 1-866-503-0857 (TTY:711) VPRIV ® (velaglucerase alfa) FAX: 1-844-268-7263 . For other lines of business: Medication Precertification Request. Please use other form. Page 2 of 2 Note: Vpriv is non-preferred. The (All fields must be completed and legible for Precertification Review.) preferred products are Cerezyme and Elelyso. Patient ...1-866-503-0857 . For other lines of business: Please use other form. Note: Inflectra is non-preferred. Preferred products vary based on indication. See section G below. (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date / / Continuation of therapy: Date of last treatment / /1-866-503-0857 . For other lines of business: Please use other form. Note: Xgeva is non-preferred. The preferred products are pamidronate or zoledronic acid. Pamidronate and zoledronic acid do not require precertification. (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date:1-866-752-7021 . Sandostatin, Sandostatin LAR Depot . FAX: 1-888-267-3277 . or Bynfezia Pen . For Medicare Advantage Part B: Phone: 1-866-503-0857 . Medication Precertification Request . FAX: 1-844-268-7263 . Page 3 of 3 (All fields must be completed and legible for precertification review) - Patient First Name . Patient Last Name . Patient ...1-866-503-0857 . For other lines of business: Please use other form. Note: Entyvio is preferred on MA (All fields must be completed and legible for precertification review.) and MAPD plans. Please indicate: Start of treatment: Start date. Continuation of therapy: Date of last treatment . Precertification Requested By: Phone: Fax: A. PATIENT ...Pioneered by WeChat almost four years ago, mini-apps are now common in China and India, and gaining traction in other markets, too. Mini-apps, or lightweight apps designed for inte...1-866-503-0857 . For other lines of business: Please use other form. Note: Renflexis is non-preferred. Preferred products vary based on indication. See section G below. (All fields must be completed and legible for Precertification Review.) Please indicate: Start of treatment: Start date / / Continuation of therapy: Date of last treatment / /1-866-503-0857 . For other lines of business: Please use other form. Note: Inflectra is non-preferred. Preferred products vary based on indication. See section G below. (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date / / Continuation of therapy: Date of last treatment / /Remicade® (infliximab) Injectable Medication Precertification Request. Page 1 of 5. (All fields must be completed and legible for precertification review.) FAX: 1-844-268-7263. PHONE: 1-866-503-0857. For other lines of business: Please use other form. Note: Remicade is preferred for MA plans. Preferred status for.Specialty Pharmacy Clinical Policy Bulletins. Aetna Non-Medicare Prescription Drug Plan. Subject: Remicade. Drug. Remicade® (infliximab) Note: Precertification review for these medications is handled through Aetna Specialty Precert Unit at 1-866-503-0857. Site of Care Utilization Management Policy applies. For information on site of service ...1-866-503-0857 . For other lines of business: Please use other form. Note: Entyvio is preferred on MA plans. On MAPD plans Entyvio is preferred for ulcerative colitis and non-preferred for Crohn’s disease. (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date / /There are 7.18 billion human beings on the planet today. And there are 7.07 billion mobile phone connections. But those belong to fewer than 3.6 billion unique subscribers, or just...1-866-752-7021 . FAX: 1-888-267-3277 . For Medicare Advantage Part B: Phone: 1-866-503-0857 . FAX: 1-844-268-7263 . Zolgensma (onasemnogene abeparvovec-xioi) Medication Precertification Request. Page 1 of 2 (All fields must be completed and legible for Precertification Review) Please indicate: Start of treatment: Start date. Continuation of ...503 Sunport Lane, Orlando, FL 32809. Phone: 1-866-503-0857 . FAX: 1-888-267-3277 . For Medicare Advantage Part B: (All fields must be completed and legible for Precertification Review.) FAX: 1-844-268-7263 Please indicate: Start of treatment: Start date . Continuation of therapy: Date of last treatment . Precertification Requested By: Phone: Fax:Drug: Cerdelga™ (eliglustat) Cerezyme® (imiglucerase) Elelyso™ (taliglucerase alfa) Vpriv™ (velaglucerase alfa) Zavesca® (miglustat) Note: Precertification review for all medications except Cerdelga are handled through Aetna Specialty Precert Unit at 1-866-503-08571-866-752-7021 Medication Precertification Request FAX: 1-888-267-3277 Page 2 of 2 For Medicare Advantage Part B: egible for Precertification Review.) Phone: 1-866-503-0857 FAX: 1-844-268-7263 Patient First Name . Patient Last Name . Patient Phone . Patient DOB . G. CLINICAL INFORMATION (continued)1-866-752-7021 . Medication Precertification Request . FAX: 1-888-267-3277 . Page 2 of 2 For Medicare Advantage Part B: Phone: 1-866-503-0857 FAX: 1-844-268-7263 (All fields must be completed and legible for Precertification Review.) Patient First Name . Patient Last Name . Patient Phone . Patient DOB . G. CLINICAL INFORMATION (continued)Exception: Requests for drugs administered by a healthcare professional that will be billed to the medical plan, call 1-866-503-0857 or fax applicable request forms to 1-888-267-3277. Policy: Note: The provision of physician samples does not guarantee coverage under the provisions of the pharmacy benefit.1-866-752-7021 Medication Precertification Request FAX: 1-888-267-3277 Page 2 of 2 For Medicare Advantage Part B: (All fields must be completed and legible for Precertification Review.) Phone: 1-866-503-0857 FAX: 1-844-268-7263 G. CLINICAL INFORMATION (continued)1-866-503-0857 . For other lines of business: Please use other form. Note: Tremfya is non-preferred. Preferred products vary based on (All fields must be completed and legible for precertification review.) indication. See section G below. Please indicate: Start of treatment: Start date . Continuation of therapy: Date of last treatmentTherefore, the airSlate SignNow web application is a must-have for completing and signing 866 503 0857 on the go. In a matter of seconds, receive an electronic document with a legally-binding eSignature. Get 866 752 7021 signed right from your smartphone using these six tips: Type signnow.com in your phone’s browser and log in to your account.Aetna Specialty Pharmacy phone: 1 (866) 503-0857; All Aetna Forms; By State. California; Colorado; Massachusetts; Michigan; Oregon; Texas (Rx Only) Texas (Services Only) How to Write. Step 1 - Begin by providing the patient's Aetna member number, group number, and specify whether or not the patient is enrolled in Medicare.If you are not the intended recipient, you are notified that any use, distribution or copying of the attached material is strictly prohibited and may subject you to criminal or civil penalties. If you received this transmission in error, please notify us immediately by telephone at (866) 503-0857. GR-69377 (5-18)Phone: 1-866-752-7021 . FAX: 1-888-267-3277 . For Medicare Advantage Part B: Phone: 1-866-503-0857 . FAX: 1-844-268-7263 (All fields must be completed and legible for Precertification Review) Please indicate: Start of treatment: Start date . Continuation of therapy, Date of last treatment . Precertification Requested By: Phone: Fax: A. PATIENT ...Precertification review for these medications is handled through Aetna Specialty Precert Unit at 1-866-503-0857. Exception: Member's enrolled in an Individual Plan for the following pharmacy covered drugs - Actemra, Amevive, Cimzia, Cosentyx, Enbrel, Humira, Kineret, Orencia, Otezla, Simponi, Stelara, and Xeljanz please contact Aetna Pharmacy Management Precertification at 1-855-240-05351-866-368-5463 www.dmv.state.va.us Disability Assistance Department for Aging & 6340 Center Dr. Bldg 7, Ste 101 (757)451-7101 www.vadrs.org * ... 503 15th St. Virginia Beach, VA 23451 (Appt. Only) (757)962-3567 www.pinministry.org St. Mark's Catholic Church 1505 Kempsville Rd.1-866-503-0857 . For other lines of business: Please use other form . Note: Procrit and Epogen are non-preferred. The preferred products are Aranesp and Retacrit. (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date / / Continuation of therapy: Date of last treatment / /1-866-503-0857 . or fax applicable request forms to . 1-888-267-3277, with the following exceptions: • For precertification of pharmacy-covered specialtydrugs (noted with*) when memberis enrolled in a commercial plan, call . 1-855-240-0535 . or fax applicable request forms to . 1-877-269-9916 • Providers can use the drug-specificPhone: 1-866-503-0857 FAX: 1-888-267-3277 For Medicare Advantage Part B: Phone: 1-866-503-7021 FAX: 1-844-268-7263 G. CLINICAL INFORMATION (Continued) - Required clinical information must be completed in its entirety for all precertification requests. Please indicate which eye the treatment is being requested for?Drug: Otezla® (apremilast) Note: Precertification review for this medication is handled by Aetna Pharmacy Management Precertification at 1-855-240-0535 or fax applicable request forms to 1-877-269-9916. Exception: Requests for drugs administered by a healthcare professional that will be billed to the medical plan, call 1-866-503-0857 or fax applicable request forms to 1-888-267-3277.1-866-503-0857 . For other lines of business: Please use other form. Note: Entyvio is preferred on MA plans. On MAPD plans Entyvio is preferred for ulcerative colitis and non-preferred for Crohn's disease. (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date / /1-866-752-7021 . Sandostatin, Sandostatin LAR Depot . FAX: 1-888-267-3277 . or Bynfezia Pen . For Medicare Advantage Part B: Phone: 1-866-503-0857 . Medication Precertification Request . FAX: 1-844-268-7263 . Page 3 of 3 (All fields must be completed and legible for precertification review) - Patient First Name . Patient Last Name . Patient ...1-866-752-7021 . FAX: 1-888-267-3277 . For Medicare Advantage Part B: Phone: 1-866-503-0857 . FAX: 1-844-268-7263 (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date / / Continuation of therapy, Date of last treatment / / Precertification Requested By: Phone: Fax: A. PATIENT ...Diabetic Testing Supplies Prior Authorization Request Form Ph: (866) 503-0857 Fax: (877) 269-9916 . MEMBER INFORMATION Member name . Member ID . Member Address, City, State, ZIP1-866-503-0857 . For other lines of business: Please use other form. Note: Fulphila, Nyvepria and Ziextenzo are non-preferred. Neulasta/Neulasta Onpro and Udenyca are preferred. (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date / / Continuation of therapy: Date of last ...1-866-503-0857 . For other lines of business: Please use other form. Note: Xgeva is non-preferred. The preferred products are pamidronate or zoledronic acid. Pamidronate and zoledronic acid do not require precertification. (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date:1-866-503-0857 . For other lines of business: Please use other form. Note: Xgeva is non-preferred. The preferred products are pamidronate or zoledronic acid. Pamidronate and zoledronic acid do not require precertification. (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date:PHONE: 1-866-503-0857 (TTY: 711) For other lines of business: Please use other form. Note: Eylea and Eylea HD are non-preferred. The preferred product is bevacizumab (Avastin). Avastin (C9257) and bevacizumab biosimilars do not require precertification for ophthalmic use. (All fields must be completed and legible for precertification review.)Specialty Pharmacy Clinical Policy Bulletins. Aetna Non-Medicare Prescription Drug Plan. Precertification review for these medications is handled through Aetna Specialty Precert Unit at 1-866-503-0857. Site of Care Utilization Management Policy applies. For information on site of service for Remicade, see Utilization Management Policy on Site ...Free essays, homework help, flashcards, research papers, book reports, term papers, history, science, politicsFor Medicare Advantage Part B: Phone: 1-866-503-0857 FAX: 1-844-268-7263. G. CLINICAL INFORMATION (continued) – – Required clinical information must be completed in its entirety for all precertification requests. Yes No Was the patient prescribed the requested drug due to clinical worsening after receiving gene replacement therapy (e.g ...FAX: 1-844-268-7263. For other lines of business: Please use other form. Note: Daxxify, Dysport and Myobloc are non-preferred. The preferred products are Botox and Xeomin. Precertification Requested By: A. PATIENT INFORMATION.Drug: Botox® (onabotulinumtoxinA) Dysport® (abobotulinumtoxinA) Myobloc® (rimabotulinumtoxinB) Xeomin® (incobotulinumtoxinA) Note: Precertification review for these medications is handled through Aetna Specialty Precert Unit at 1-866-503-08571-866-503-0857 . or fax applicable request forms to . 1-888-267-3277, with the following exceptions: • For precertification of pharmacy-covered specialtydrugs (noted with*) when memberis enrolled in a commercial plan, call . 1-855-240-0535 . or fax applicable request forms to . 1-877-269-9916 • Providers can use the drug-specificPolicy: Precertification Criteria; Under some plans, including plans that use an open or closed formulary, Benlysta is subject to precertification. If precertification requirements apply Aetna considers Benlysta to be medically necessary for those members who meet ALL of the following precertification criteria:1-866-503-0857 . For other lines of business: Please use other form. Note: Inflectra is non-preferred. Preferred products vary based on indication. See section G below. (All fields must be completed and legible for precertification review.) Please indicate: Start of treatment: Start date / / Continuation of therapy: Date of last treatment / /Exception: Requests for drugs administered by a healthcare professional that will be billed to the medical plan, call 1-866-503-0857 or fax applicable request forms to 1-888-267-3277. For Oral Corticosteroid Clinical policy click here . Policy:. 1-866-752-7021 . Sandostatin, Sandostatin 1-866-503-0857 . For other lines of busin Phone: 1-866-752-7021. Medication Precertification Request. FAX: 1-888-267-3277. Page 1 of 2 For Medicare Advantage Part B: (All fields must be completed and legible for precertification review.) Phone: 1-866-503-0857 FAX: 1-844-268-7263. Please indicate: Start of treatment: Start date / / Continuation of therapy: Date of last treatment ...Exception: Requests for drugs administered by a healthcare professional that will be billed to the medical plan, call 1-866-503-0857 or fax applicable request forms to 1-888-267-3277. For Oral Corticosteroid Clinical policy click here . Policy: 1-866-752-7021 (TTY: 711) (commercial) or : 1-866-503-0857 ( If it is medically necessary for a member to be treated initially with a medication subject to step-therapy, the member, a person appointed to manage the member's care, or the member's treating physician may contact the Aetna Pharmacy Management Precertification Unit to request coverage as a medical exception at 1-866-503-0857 (See Medical ...Phone: 1-866-752-7021 FAX: 1-888-267-3277 For Medicare Advantage Part B: Phone: 1-866-503-0857 FAX: 1-844-268-7263 (All fields must be completed and legible for Precertification Review.) Please indicate: Start of treatment: Start date. Continuation of therapy: Date of last treatment. Phone: 1-866-503-0857 (TTY:711) VPRIV ® (velagluce...
Continue Reading