Prescription Medications & Pharmacy Management
Precertification to be required for five drugs
Effective January 1, 2010, all commercial pharmacy plans (fully and self-insured) will require precertification and impose quantity limits* for the following potentially dangerous
prescription drugs: n Actiq/Fentora OxyContin/Oxycodone SR Duragesic/Fentanyl patch Combunox/oxycodone/ibu Butorphanol/Stadol NS n n n n
Currently, only fully insured commercial pharmacy plans require precertification and impose quantity limits on these drugs.
Together with the Food and Drug Administration (FDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA), we are concerned about the rise of
prescription painkiller use and increase in related hospital admissions.
To address this concern, we are taking steps to support safer and more appropriate drug therapy, including requiring precertification for the drugs listed above. The same clinical criteria
will now apply for the self-insured plans, with the exception of the quantity limit for Actiq/Fentora. The quantity limit will be 120 units per 30 days, instead of 15 units per 30 days.
How to precertify and get more information You can precertify these medications through our secure provider website via NaviNet or by calling the telephone number listed on the member’s ID card.
To view Aetna’s Clinical Policy Bulletins, visit www.aetna.com, select “Health Care Professionals” then “Medical,” and “Clinical Policy Bulletins.”
*Precertification and quantity limits may not apply in all service areas and are subject to change.
Get formulary information quickly and easily
We periodically update the Aetna Medicare and Commercial Preferred Drug Lists, also known as our formularies.
For up-to-date formulary information on Aetna’s Medicare Advantage/Part D and Medicare Part D prescription drug plans, visit http://www .aetnamedicare . com/plan_choices/rx_find_ prescriptions .jsp.
For up-to-date commercial formulary information, visit http://www .aetna .com/FSE/ planTypedo?businessSector Code=CM.