Tag: Drug Coverage
UHC Network Bulletin Overview 8/2021
Your NOTICE of protocol
and policy changes
from UnitedHealthcare
Medical policy updates: August 2021
This month, you’ll find updates for Medicaid, Medicare, Exchange and commercial plans.
Prior authorization and notification requirement updates
We’re making changes to certain advance notification and prior authorization requirements that are available for you in the 2021 Summary of Changes.
Reimbursement policy updates: August 2021
This month, you’ll find updates for Medicaid and commercial plans.
Specialty Medical Injectable Drug program updates: August 2021
See the latest updates to requirements for Specialty Medical Injectible Drugs for UnitedHealthcare members.
Prior authorization code updates for commercial plans
Effective Nov. 1, 2021, we are adding new codes to the prior authorization list for UnitedHealthcare commercial plans including All Savers, River Valley, Neighborhood Health Partnership, UnitedHealthcare West, MidAtlantic Health Plans
Aetna OfficeLink Updates 6/1/2021
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Open in new tab Step Therapy Requirement
Cigna Medicare Advantatge
The goal of step therapy is to help achieve lower drug prices while maintaining access to drugs for patients.
Certain Part B drugs that currently require precertification will also require step therapy.
The list of drugs that require step therapy can change throughout the plan year.
Aetna Commercial Drug Changes
Changes to Aetna's Commercial Drug Lists
On July 1, 2021, Aetna will update their pharmacy drug lists.
You’ll be able to view the changes as early as May 1, 2021. They’ll be available on our Formularies & Pharmacy Clinical Policy Bulletins page.
Ways to request a drug prior authorization
- Submit your completed request form through our provider portal on Availity
- For requests for nonspecialty drugs on Aetna Funding Advant age5M , Premier, Premier Plus, Small Group ACA and Value Plus plans, call the Precertification Unit at 1-855-240-0535 (TTY: 711). Or fax your completed prior authorization request form to 1-877-269-9916.
- For requests for nonspecialty drugs on the Advanced Control, Advanced Control – Aetna, Standard Opt Out, Standard Opt Out – Aetna, Standard Opt Out with ACSF, Aetna Health Exchange and High Value formulary plans, call the Precertification Unit at 1-800-294-5979 (TTY: 711). Or fax your completed prior authorization request form to 1-888-836-0730.
- For requests for drugs on the Aetna Specialty Drug List, call the Precertification Unit at 1-866-814- 5506 (TTY: 711). Or fax your completed prior authorization request form to 1-866-249-6155.
These changes will affect all drug lists, precertification, quantity limits and step-therapy programs. For more information, call the Provider Help Line at 1-800-238-6279 (TTY: 711) (1-800-AETNA RX).
Aetna OfficeLink Updates Published 12/1/2020
For new and updated information on:
- Changes to Aetna’s National Precertification List (NPL)
- Surgical procedures performed in the ER, modifier 54, rate change
- Beginning March 1, 2021 you may see new claim edits. These will be part of Aetna’s 3rd Party Claim and Code Review Program.
- Individual Service Codes are being assigned to Service Groups (a lot of changes are coming)
- Changes in Commercial and Medicare Drug list
- Changes in Prior Authorization Requirements
Aetna OfficeLink Updates, Published 9/1/2020
- Changes to the National Pre-Certification List
- Third Party Claim and Code Review Program
- And many interesting topics
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