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

Effective August 1, 2024, we’ll require precertification for the following:

• Anktiva® (nogapendekin alfa inbakicept-pmln) (J3490, J3590, C9399, J9999)
• Beqvez™ (fidanacogene elaparvovec-dzkt) (J3490, J3590, C9399)

Effective November 1, 2024, we'll require recertification for the following:

• Krystexxa® (pegloticase) (J2507) 

Effective November 1, 2024, we'll require site-of-care precertification for the following drug, which currently requires recertification:

• Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc) (J9334)

Submitting precertification requests
Be sure to submit precertification requests at least two weeks in advance and include the actual date of service in the request. To save time, request recertification online. Doing so is fast, secure and simple.

You can submit most requests online through our provider portal on Availity.* 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 Listspage to find out if the code requires precertification.**

If you need precertification for a specialty drug for a commercial or Medicare member, submit your request through Novologix®, also available on Availity®.

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Services Billed With a Diagnosis Considered Not Covered
Reminder: Aetna® will deny services when billed with a diagnosis considered not covered per standard plan exclusions.

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Aetna's August 2024 OfficeLink Update is Available HERE.

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