Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The member's benefit plan determines coverage. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Members should discuss any matters related to their coverage or condition with their treating provider.Įach benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Treating providers are solely responsible for medical advice and treatment of members.
The ABA Medical Necessity Guide does not constitute medical advice. The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. High Performance Generic Step Therapy (PDF)īy clicking on “I Accept”, I acknowledge and accept that: These drugs may be injected, infused or taken orally and may require special handling.Īetna Value drug list fixed-rate copay (PDF)Ĭhoosing a drug from this list will help you get the most value from your drug coverage.
Specialty drugs treat complex conditions that often require support by a nurse or pharmacist during treatment. Preferred specialty drugs and formulary excluded specialty drugs (PDF) The list shows you the non-covered drugs and the similar covered ones. There are similar products with the same active ingredients that are covered. The drugs on this list are not covered under your plan. Check your plan benefit documents for details on filling a 90-day supply of drugs on this list. For instance, arthritis, asthma, diabetes or high cholesterol. Maintenance Choice drug list includes drugs a person takes regularly to treat chronic conditions. This means they are covered 100 percent by your plan. Under health care reform, you can get some drugs and products with no member cost share. To find out which lists apply to you, check your plan benefits documents. You would be responsible only for your copay. HRA-associated plans: Prescription drugs on the Preventive list and/or the Chronic list below could be covered as if you already met your deductible. HSA-associated plans: Prescription drugs on the Preventive list below will be covered as if you have already met your deductible. These drugs appear in the main list, but have been grouped into categories to make them easier to find.
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