01/17/2023

Aetna

Aetna Managed Care Committee Member

Nicole Carlson, CCA - Oncology Hematology Associates of Saginaw Valley

Changes to our National Precertification List (NPL)
This update applies to both our commercial and Medicare members.

The following new-to-market drugs require precertification:

• Stimufend® (pegfilgrastim-fpgk) — precertification is required starting January 1, 2023. This drug is part of the Granulocyte Colony-Stimulating Factor drug category.
• Rolvedon™ (eflapegrastim-xnst) — precertification is required starting January 1, 2023. This drug is part of the Granulocyte Colony-Stimulating Factor drug category. 
• Vegzelma® (bevacizumab-adcd) — precertification is required starting January 1, 2023.
• Pedmark® (sodium thiosulfate) — precertification is required starting January 10, 2023.
• Tecvayli™ (teclistamab-cqyv) — precertification is required starting January 10, 2023.
• Zynteglo® (betibeglogene autotemcel) — precertification is required starting January 1, 2023.
• Skysona®/Lenti-D (elivaldogene autotemcel or eli-cel) — precertification is required starting January 1, 2023.
• Xenpozyme® (olipudase alfa-rpcp) — precertification is required for both the drug and site of care starting January 1, 2023. This drug is part of the Enzyme Replacement drug category.
• Spevigo® (spesolimab-sbzo) — precertification is required starting January 1, 2023. This drug is part of the Immunologic Agents drug category.
• Cimerli™ (ranibizumab-eqrn) — precertification is required starting January 5, 2023. This drug is part of the Opthalmic Medical Injectables drug category.

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Medicare Part B Preferred Drug List
Some medically administered Part B drugs may have extra requirements or limits on coverage. These may include step therapy. This is when we require you to first try certain preferred drugs to treat your medical condition before covering another non-preferred drug.

For example, if drug A and drug B both treat your condition, we may prefer drug A, and require you to try it first. If that does not work for you, we will then cover drug B. The listed preferred products should be used first. An exception process is in place for specific cases that may call for a non-preferred product.

Drug classes with preferred products are listed below. For specific medical indications subject to step
therapy, please see the corresponding clinical policy bulletin on the Aetna® website.

READ MORE - Aetna Medicare Advantage (MA) only plans  

READ MORE - Aetna Medicare Advantage plans that offer prescription drug coverage (MAPD)