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Prior authorization

Aetna Assure Premier Plus (HMO D-SNP) requires prior authorization (PA) for some acute outpatient services and planned hospital admissions. Some prescriptions drugs may also require PA. But PA isn’t required for emergency services. You can find the current list of the services that require PA on your secure Provider Portal.

 

Tips for requesting authorization

Tips for requesting authorization

A request for PA is not a guarantee of payment. We won’t reimburse unauthorized services. You can make requesting PA easier for yourself by:

 

  • Registering for the Provider Portal, if you haven’t already

Aetna Assure Premier Plus (HMO D-SNP) providers follow prior authorization guidelines. If you need help understanding any of these guidelines, please call Provider Experience at 1-844-362-0934 (TTY: 711), Monday through Friday, 8 AM to 5PM.

Part B Step Therapy

Part B Step Therapy

Under Medicare Advantage plans, some Part B drugs, like injectables or biologics, may have requirements or coverage limits. With step therapy, we require a trial of a preferred drug to treat a medical condition before covering a non-preferred drug. 

 

For example, if drug A and drug B both treat a medical condition, we may prefer drug A and require a trial with it first. If drug A doesn’t work, then we’ll cover drug B. 

 

The step therapy requirement doesn’t apply to patients who’ve already received treatment with the non-preferred drug within the past 365 days.

Find Part B Step Therapy Preferred drugs

Find Part B Step Therapy Preferred drugs

You’ll want to use the list of preferred products first. Just check the Part B Step Therapy Preferred Drug lists below for Aetna Assure Premier Plus (HMO D-SNP). 

 

2024 Medicare Part B Step Therapy Preferred Drug List (PDF)

 

2025 Medicare Part B Step Therapy Preferred Drug List (PDF)

Part B Step Therapy

Abraxane (albumin-bound paclitaxel) Medicare (PDF)
Actemra (Tocilizumab) Medicare (PDF)
Avsola (infliximab-axxq) Injectable Medicare (PDF)
Beovu (brolucizumab-dbll) Injectable Medicare (PDF)
Botulinum Toxins Medicare (PDF)
Entyvio (Vedolizumab) Medicare (PDF)
Erythropoiesis Stimulating Agents (ESAs) Medications/Dialysis Medicare (PDF)
Evenity (Romosozumab) Medicare (PDF)
Eylea (Aflibercept) Medicare (PDF)
Pegfilgrastim (Fulphila®, Neulasta®, Nyvepria®, Udenyca®, and Ziextenzo®) Medicare (PDF)
Filgrastim (Granix, Neupogen, Nivestym, Zarxio) Medicare (PDF)
Herceptin (trastuzumab) Medicare (PDF)
Ilumya (Tildrakizumab) Medicare (PDF)
Immune Globulin (IG) Therapy Medicare (PDF)
Inflectra (Infliximab) Medicare (PDF)
Lemtrada (Alemtuzumab) Medicare (PDF)
Lucentis (Ranibizumab) Medicare (PDF)
Pegfilgrastim (Fulphila®, Neulasta®, Nyvepria®, Udenyca®, and Ziextenzo®) Medicare (PDF)
Filgrastim (Granix, Neupogen, Nivestym, Zarxio) Medicare (PDF)
Filgrastim (Granix, Neupogen, Nivestym, Zarxio) Medicare (PDF)
Pegfilgrastim (Fulphila®, Neulasta®, Nyvepria®, Udenyca®, and Ziextenzo®) Medicare (PDF)
Orencia (Abatacept) Medicare (PDF)
Prolia, Xgeva (Denosumab) Medicare (PDF)
Remicade (Infliximab) Medicare (PDF)
Pulmonary Arterial Hypertension (Infusible, Inhalation, or Injectable Medication) Medicare (PDF)
Renflexis (Infliximab-abda) Medicare (PDF)
Rituxan (Rituximab) Medicare (PDF)
Simponi Aria (PDF)
Stelara (Ustekinumab) Medicare (PDF)
Tysabri (Natalizumab) Medicare (PDF)
Pegfilgrastim (Fulphila®, Neulasta®, Nyvepria®, Udenyca®, and Ziextenzo®) Medicare (PDF)
Viscosupplementation Medications Medicare (PDF)
Filgrastim (Granix, Neupogen, Nivestym, Zarxio) Medicare (PDF)
Pegfilgrastim (Fulphila®, Neulasta®, Nyvepria®, Udenyca®, and Ziextenzo®) Medicare (PDF)
Cimzia (Certolizumab Pegol) Medicare (PDF)
ESA Agents Medicare (PDF)
Leqvio (Inclisiran) Medicare (PDF)
Susvimo (Ranibizumab) Medicare (PDF)
Tremfya (Guselkumab) Medicare (PDF)
Vabysmo (Faricimab-SVOA) Medicare (PDF)
Kyprolis (PDF)
Alpha 1 (PDF)
Darzalex (PDF)
Cinqair (PDF)
Ocrevus (PDF)
Tremfya (PDF)
Fasenra (PDF)
Avastin (PDF)
Somatuline (PDF)
Zoladex (PDF)
Trelstar (PDF)
Darzalex Faspro (PDF)
Feraheme (PDF)
Signifor (PDF)
Lupron (PDF)
IVIG (PDF)
 

 

How to request PA

 

Here are the ways you can request PA:

Online

You can request PA through our secure Provider Portal.

By phone

You can also request PA by calling 1-844-362-0934 (TTY: 711).  

For more information

Check your Provider Manual (PDF). Or call us at 1-844-362-0934 (TTY: 711).  We're here from 8 AM to 5 PM, Monday through Friday.

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