The drug my doctor prescribed requires precertification, step-therapy or has quantity limits. How can I get an exception if necessary?
Depending on your plan, you may have to meet certain requirements before some drugs will be covered. These requirements include precertification, step therapy and quantity limits. Your doctor may have prescribed a drug, which requires precertification, step therapy or quantity limits. In these cases, your doctor can ask for an exception to have the drug covered by your prescription benefits plan. An exception is only given if the drug is medically necessary to treat your condition. Aetna can work closely with your doctor to quickly review and potentially fulfill the request. We work with your doctor to collect and review medical information about your diagnosis. This includes applicable lab results, other drugs you may have tried for your condition and the results of you trying those drugs. To request an exception, your doctor can reach us in one of the following ways: 1. Call the Aetna Pharmacy Precertification Unit at 1-800-414-2386. 2. Fax a Medical Exception/Precertification Reques
Depending on your plan, you may have to meet certain requirements before some drugs will be covered. These requirements include precertification, step therapy and quantity limits. Your doctor may have prescribed a drug, which requires precertification, step therapy or quantity limits. In these cases, your doctor can ask for an exception to have the drug covered by your prescription benefits plan. An exception is only given if the drug is medically necessary to treat your condition. Aetna can work closely with your doctor to quickly review and potentially fulfill the request. We work with your doctor to collect and review medical information about your diagnosis. This includes applicable lab results, other drugs you may have tried for your condition and the results of you trying those drugs.
Related Questions
- What needs to be done if a medically necessary drug is not on a plans formulary or requires prior authorization? Is there an exception or appeal process?
- The drug my doctor prescribed requires precertification, step-therapy or has quantity limits. How can I get an exception if necessary?
- I received fewer pills than the doctor prescribed. Is there a quantity limit on medications?
