Tag: Pharmacy
BCBS Pharmacy Qtrly Updates for January 2026
Pharmacy Program Quarterly Update Changes Effective Jan. 1, 2026 – Part 1
Aetna March OfficeLink Updates
Changes in Aetna’s Commercial Drug List Begin on July 1, 2024.
Per Aetna, Changes may affect all drug lists, precertification, step therapy and quantity limit programs. Physician offices can view the changes as early as May 1, 2024. The changes can be found on Aetna’s Formularies and Pharmacy Clinical Policy Bulletins page.
Changes in Aetna’s National Precertification List (NPL)
This applies to both Aetna Commercial and Medicare Members. (POET does not have an Aetna Medicare contract at this time.) Per Aetna this change will also be effective July 1, 2024. They will require precertification for:
- Osteotomy posterolateral approach, thoracic
- Osteotomy anterior approach
- Knee meniscectomy-requires precertification for the Medicare Advantage members only.
Per Aetna, Be sure to submit precertification requests at least two weeks in advance. To save time, request precertification on line.
Updated Clinical Prior Authorization
Assistance Chart Now Available
An update to the Clinical Prior Authorization Assistance Chart is available. The chart identifies which clinical prior authorization each MCO uses and whether the MCO uses all or some of the steps in the evaluation process.
BCBS Pharmacy Quarterly Update
Changes Effective October 1, 2023
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