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Quality health plans & benefits
Healthier living
Financial well-being
Intelligent solutions
March 2012 • Volume 9, Issue 1
Aetna
OfficeLink Updates
TM
Southeast Region
Do you have an ICD-10 conversion plan?
Inside This Issue
Policy and Coding Updates 2-3
Electronic Solutions
Office News
4
5-6
Learning Opportunities
Southeast News
7
10
The October 1, 2013 compliance deadline for
new coding standards is approaching. We
encourage you to develop a project plan, think
about budget planning and meet with all
impacted areas of your organization.
This can be costly and time-consuming, so we
urge you to plan now to meet this date.
According to industry surveys, developing a
project plan for converting to ICD-10 is a major
concern for providers and their staff. To learn how to develop a project plan, click here.
Options to reach us
More resources
• Go to www.aetna.com
• Select “Health Care
• Log in to the Aetna Education Site . From the
top toolbar, select “Office Staff Courses” then
“Coding” and “HIPAA 5010 Transaction
Upgrade Overview” and “ICD-10 Overview.”
Professionals”
• Select “Medical Professionals
Log In”
• Click here to go to Aetna’s “5010, ICD-10 and
NPI” web page.
Who must comply
All health care providers who use standard
electronic transactions and all health plans and
clearinghouses must comply with the new
transaction and coding standards.
We plan to meet all applicable timeframes
for compliance and will work closely with you,
as well.
Or call our Provider Service Center:
•1-800-624-0756 for HMO-based
benefits plans, Medicare
Advantage plans and WA Primary
Choice plan
•1-888-MDAetna
(1-888-632-3862)
for all other plans
48.22.808.1-Q1-SE (3/12)
How to update your demographic information
It’s easier than ever to update or correct your
office’s or facility’s phone and fax number(s),
mailing addresses and e-mail addresses.
Use our new Request Changes to Provider Data
form. It’s located on our DocFind® provider
directory.
Updating this information will help ensure
that you receive important information we
distribute – whether by e-mail or on paper. It also
will provide patients who use DocFind with the
most up-to-date and accurate information
about where you’re located or how to reach you.
www.aetna.com
Policy and Coding Updates
Clinical payment, coding and policy changes
We regularly adjust our clinical, payment and coding policy positions as part of our ongoing policy review processes. In developing our
policies, we may consult with external professional organizations, medical societies and the independent Physician Advisory Board,
which provides advice to us on issues of importance to physicians. The accompanying chart outlines coding and policy changes:
Procedure
Implementation
date
What’s changed
95165 – Professional services for the
supervision of preparation and provision of
antigens for allergen immunotherapy; single
or multiple antigens
6/1/2012
95165 will be allowed 30 times per date of service.
D9610 – Therapeutic parenteral drug, single
administration
6/1/2012
D9610 will be denied as incidental when billed with codes D9220,
D9221, D9241 or D9242. Modifier 59 will override the edit.
Medicare status codes (P and M)
6/1/2012
Codes designated with a P (bundled/excluded codes) or M
(measurement code for reporting services only) Medicare
Physician Fee Schedule status code is not payable and will
be denied.
J9055 – Injection, cetuximab, 10 mg
6/1/2012
Effective 6/1/2012, cetuximab (Erbitux) will be considered
experimental and investigational for the treatment of glioma and
vaginal cancer. Refer to Clinical Policy Bulletin #0684
(Cetuximab (Erbitux)) for more information.
Qualitative drug screen codes G0431 &
G0434
6/1/2012
Starting 6/1/2012, we will require the use of either G0431 or
G0434 for the billing of qualitative drug screens.
We will reimburse for 1 unit, per patient encounter, of either code
when qualitative testing methods are used. Any billing of CPT
codes 80100, 80101 or 80104 will be adjudicated according to
this policy with appropriate mapping to one unit of G0431 or
G0434 per patient encounter.
Inappropriate billing or coding
Annual reminder
We make code adjustments for inappropriate billing or coding.
Examples of these adjustments include rebundling of services
that are considered part of, incidental to, or inclusive to the
primary procedure as well as adjustments for mutually
exclusive procedures.
93224 – 93227 – External
electrocardiographic recording up to 48
hours by continuous rhythm recording and
storage
Reminder
93224 – 93227 are used to report external electrocardiographic
recording services of up to 48 hours. These procedure codes
should be reported once within a 48 hour time period.
Shingles vaccine is covered for ages 60+
Although the FDA has approved use for 50 years and older, we are
following the recommendations of the Centers for Disease
Control’s (CDC) Advisory Committee on Immunization
Practices (ACIP), which recommends a shingles vaccine for persons
age 60 years and older. To learn more, read the Clinical Policy
Bulletin online – search for #115.
Clarification: Polysomnography precert requirements
In our December issue, we noted that effective March 1, 2012, all
markets will require preauthorization for polysomnography. This
change will take effect in Texas beginning May 1, 2012. We also
wish to clarify that preauthorization is required only in markets
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Aetna OfficeLink Updates
where the radiology benefits management program currently
applies. Additional information from Aetna and MedSolutions, Inc.
or CareCore National will be forthcoming
Preauthorization now required for cardiac implant devices
Effective June 1, 2012, we will require
preauthorization for non-emergent
cardiac implant devices.
This affects all plans. This change includes
Aetna patients who already require
preauthorization through our current
high-tech radiology imaging
preauthorization program.
preauthorization. You can reach
MedSolutions:
•Online at
www.medsolutionsonline.com
•By phone at 1-888-693-3211
•By fax at 1-888-693-3210
Providers in New York and New Jersey
should contact CareCore National to
request preauthorization. You can reach
CareCore National:
•Online at www.carecorenational.com
•By phone at 1-888-622-7329 in New
York or 1-888-647-5940 in New Jersey
•By fax at 1-888-444-1562
As of June 1, 2012, providers in all states,
except New York and New Jersey, should
contact MedSolutions to request
Changes to the National Precertification List (NPL)
The following precertification changes are
effective on July 1, 2012:
•Aetna is adding Proton Beam
Radiotherapy to the NPL
•T he phone and fax numbers for all drugs
on Aetna’s NPL will be centralized:
- Phone: 1-866-503-0857
- Fax: 1-888-267-3277
A reminder about a previously
communicated addition to Aetna’s
National Precertification List:
• Adceteris* – requires precertification
effective May 1, 2012
To review the NPL, click here.
MARCH 2012
3
Electronic Solutions
Aetna’s EDI transactions – making it simple for you in 2012
We offer a variety of electronic options on our secure provider website.
Our electronic transaction vendors also offer electronic options. We encourage you to use these transactions to suit your needs
and make your interactions with us easier.
If you don’t have a user name and password to our website, click here.
Verify benefits, see patient responsibility amounts
The new year means new plans for your
patients. Copayments, coinsurance, and
deductibles might not be the same as last
year. These tools can help:
Our Eligibility and Benefits Inquiry
(E&B):
•Gives you real-time information
•Lets you verify past benefits,
copayments, coinsurance, and deductible
amounts
Our Provider Payment Estimator:
•Shows you patient responsibility amounts
before or at the time of service
•Supplements eligibility with estimates
that show copayments, coinsurance, and
deductibles using claims data, your
office’s fee schedule, and claims
processing rules
•Now offers enhanced responses for
patients who have tiered benefit plans
•Is available on Aetna’s secure provider
website
•Enables you to print the results to share
with patients prior to rendering services
Reminder: submit your precerts online
For services requiring prior notification,
why wait on the phone when you can
submit your requests online from our
secure provider website? Or, by using
another vendor that offers this
transaction?
•Recent enhancements to the
Precertification Submission transaction
on our secure provider website include:
--D ynamic pages – depending on the type
of precertification request (Inpatient,
Outpatient, DME, Ambulance, or
Office), your choices direct you what to
fill out next
--Transactions move from E&B to
Precertification without having to
re-enter patient information
--Contact information saves the last
name entered
--Precertification Status Updates are
accessible via daily alert when a
submitted precertification request has a
status change
Training
We offer a “Hands on the Keyboard”
electronic precertification training
Tuesdays at 1 p.m. ET (inpatient) or
Wednesdays at 2 p.m. ET (outpatient/
DME). To attend, e-mail your name,
practice name and address, and telephone
number to PeSHOTKePrecertTraining@
aetna.com. An Aetna representative will
contact you.
Advantages of electronic EOBs, EFT, ERA
Whether you recently began using
electronic EOBs or are looking for an easier
way to reconcile your Aetna EOBs, you can
get electronic copies of your EOBs from
our secure provider website. Registered
users can access electronic EOB copies for
up to the past two years.
Electronic EOBs go hand in hand with
Electronic Funds Transfer (EFT)
•EFT is free and your account information
is secure
•Enroll in EFT, and receive claims
payments up to a week faster than by
paper check. Payments are directly
deposited into your bank account(s)
•Get an EFT enrollment form here
We also offer Electronic Remittance
Advice (ERA) to offices able to receive
these files. Click here to learn more
about ERA and to get an ERA/EFT
enrollment form.
Want your claims paid faster? Here’s how
Submit all of your claims electronically, including your secondary
claims. (Click here to learn how to submit secondary claims to us.)
•Registered users of our secure provider website can submit all of
your claims electronically – free of charge
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Aetna OfficeLink Updates
Aetna OfficeLink Updates
•You can also use one of our electronic transaction vendors
We’re so committed to processing your claims as quickly as
possible that we’ve signed onto the American Medical
Association’s pledge to “Heal the Claims Processtm Campaign.”
Office News
Help us promote medication adherence
Statistics show that 20 to 80 percent of
patients don’t take their medication as
prescribed. As many as 83 percent don’t
tell their physician that they aren’t planning
to fill their prescription(s).1 Patients take
medications based on their understanding
of their diagnosis and treatment plan.
Effective communication
The good news is prescribers can improve
medication adherence by communicating
more effectively with their patients. These
strategies can help: 2
•Give clear information about the
patient’s condition. Using simple
language is crucial to patients’
understanding of their illness. It will help
them make decisions about their
medications.
•Involve the patient in the plan. Patients
want to discuss how the medication
works, its benefits, efficacy, side effects
and any alternate therapies. This
knowledge helps patients follow their
provider’s recommendations.
•Foster a relationship of trust. There’s a
link between the patient/practitioner
relationship and medication adherence.
Studies show that when this relationship
is strong, adherence is better.
Online resources
Check out these provider/patient resources
on our secure provider website under
Clinical Resources:
•Medication Adherence Assessment
Form – Taking your medicines as
prescribed is important
•Fact Sheet – Helping your patients
overcome barriers to medication
adherence
•Tip Sheet – Tips to help remind you to
take your medicine
Benson J, Britten N. (2002). Patients’ decisions
about whether or not to take antihypertensive
drugs: qualitative study. BMJ. 325,873-877.
2
Zolnierek K, DiMatteo R. (2009). Physician
communication and patient adherence to
treatment: a meta-analysis. Med Care. 47(8),
826–834.
1
Aetna’s face is changing – here’s why
Beginning this spring, be on the lookout for
patients with Aetna ID cards sporting our
new logo. (During this transition, you can
still accept ID cards with the old logo.)
You may have noticed our new look. We’re
proud of our vibrant colors and bold logo.
They capture our passion for building
relationships with our members and
providers.
Click here to request permission to
download a copy of our new logo for your
website or office.
decisions, and make it easier for them to
live healthier. Our new logo reflects
this promise.
Watch a video to learn more about our
commitment to connecting our members
to healthier living.
We’re continually changing to help our
members feel confident in their health care
Where to find product type on ID cards
The number on your patient’s member ID (e.g., W or other alpha numeric) should not be used as an indicator of the product type. Instead,
you’ll find the product type in the upper right corner of the patient’s member ID card.
You can continue to get eligibility and benefits information online, using our secure provider website.
Medicare
Contact us for approval of communications that mention Aetna
The Centers for Medicare & Medicaid Services (CMS) has established specific marketing guidelines for communicating with Medicare
beneficiaries. To review CMS marketing requirements, see their Final 2012 Medicare Marketing Guidelines (scroll to bottom of page to
access the files).
Any Medicare-related communications you develop that reference Aetna and that you intend to distribute to Aetna Medicare members
must be reviewed and approved by Aetna and CMS, where required, prior to distribution. Your Aetna network representative can help
you get the required Aetna and CMS approvals.
MARCH 2012
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Our online Toolkit has useful information
In our Health Care Professional Toolkit,
available on our secure provider website,
you’ll find information about our case
management and disease management
programs.
The Toolkit has information that can help
you serve your Aetna patients efficiently
and accurately. The Toolkit is a streamlined,
comprehensive office manual that
contains information about:
•Aetna policies and procedures
•Patient management and acute care
•Special member programs/resources,
including the Aetna Women’s HealthSM
Program, Aetna Compassionate CareSM
and others
Click here to access the Toolkit. Or, after
logging in to our secure website, select
“Doing Business with Aetna” from the
Aetna Support Center.
If you don’t have Internet access, call our
Provider Service Center for a hard copy:
•1-800-624-0756 for HMO-based
benefits plans, Medicare Advantage plans
and WA Primary Choice plan.
•1-888-MDAetna (1-888-632-3862) for
all other plans.
•Clinical Practice and Preventive Service
guidelines
Note our one phone number for drugs needing precert
You now only have to use one phone/fax
number when contacting us for drug
precertification for all drugs on the Aetna
Participating Provider Precertification List.
Begin using these numbers immediately
when contacting us for drug
precertification:
•Phone: 1-866-503-0857
•Fax: 1-888-267-3277
As a reminder, drugs on the list are subject
to precertification for all benefits plans,
excluding Traditional Choice plans.
View the Precertification List for a full list
of drugs.
Medication forms
You can find Medication Request forms on
our secure provider website. Once logged
in, select “Aetna Support Center” from the
Aetna Plan Central home page, then
“Forms Library” and “Pharmacy Forms.”
Links to our Medicare and Commercial formularies
We update the Aetna Medicare and
Commercial (non-Medicare) Preferred
Drug Lists, also known as our formularies,
at least annually and from time to time
throughout the year.
•Go to our Commercial Preferred Drug
List
•Go to our Medicare formulary
For paper copies of these guides, call
1-800-AetnaRx (1-800-238-6279).
sent your Part A claim to Aetna. There is no
need for you to send in a claim. You can
check claim status with our electronic
Claim Status Inquiry transaction and follow
up with us in 30 days, if needed.
For more information, visit our dedicated
COB claims page. From there, use the
“Contact Aetna” link to submit questions.
We now accept Part A claims
Aetna can now accept your Medicare
Part A claims electronically.
Review your Medicare Explanation of
Payments for one of these two codes:
MA18 or N89. If you see one of these
codes, then Medicare has automatically
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Aetna OfficeLink Updates
Learning Opportunities
Aetna’s Education Site for Health Care Professionals
Log in or register at www.AetnaEducation.com.
New and updated courses for physicians, nurses and office staff
Cultural Competency
•Updated Provider Manuals: Behavioral Health Provider Manual
• New Cross-Cultural Issues in Genetic Counseling
•Updated Provider Manuals: Employee Assistance Program (EAP)
Manual
Reference Tools
• New Products, Programs and Plans: Passport To Healthcare®
Webinars
•Updated Products, Programs and Plans: Aexcel® reference tool
• New Doing Business with Aetna Live Webinar
•Updated Products, Programs and Plans: Nonparticipating
Provider Information: Aetna Medicare Plan (PPO)
“Spring” into a new season - you could win a prize
Spring represents renewal and change. Beginning in March, if you
“spring” into education, you’ll have another chance to learn with
us and maybe walk away with a prize.
To start:
Or, if you have completed the courses listed above, you can
complete the “ICD-10 Overview.” Check out www.AetnaEducation.com starting March 1, 2012 to
learn more.
•Log in to www.AetnaEducation.com.
•Complete Quality Interactions® for Health Care Employees or
Quality Interactions for Physicians (2.5 CME credits), or any
Quality Interactions refresher course. These courses are a great
way to support National Minority Health Month in April.
March is National Nutrition Month
Pediatricians, nurses and office staff – we have training videos readily available designed to
help prevent children from being overweight.
In the GetNHealthy Nutrition Counseling Videos, Inger Hustrulid, RD, LDN, ACSM, walks you
through basic communication, counseling and interview techniques. This can help individuals
and families establish life-long health through innovative programs, interactive activities and
nutrition counseling.
Take time to view these resources today; this information will go a long way to encourage
healthy eating habits.
To view the videos, log in to www.AetnaEducation.com. Select “Office Staff Courses” from
the top toolbar, view the Products, Programs and Plans course catalog, then select
“GetNHealthy Nutritional Counseling Videos.”
Download our course
catalog
Explore our wide range
of courses
MARCH 2012
7
Review our policies on non-discrimination, accessibility
Our Health Care Professional Toolkit,
available on our secure provider website,
includes important information on all
member rights and responsibilities,
including those about discrimination.
It also contains information about
accessibility standards.
If you don’t have Internet access, call our
Provider Service Center for a paper copy of
the Toolkit.
Non-discrimination policy
All participating physicians should have a
documented non-discrimination policy.
Federal and state laws prohibit
discrimination in the treatment of patients
on the basis of: race, ethnicity, national
origin, religion, sex, age, mental or physical
disability, medical condition, sexual
orientation, claims experience, medical
history, evidence of insurability (including
conditions arising out of acts of domestic
violence), genetic information or source of
payment.
All participating physicians or health care
professionals may also be obligated under
the Americans with Disabilities Act to
provide physical access to their offices and
reasonable accommodations for patients
and employees with disabilities.
Accessibility standards
The Toolkit includes accessibility standards
for primary care physicians. Accessibility
standards for specialists are specific to
your state and specialty. Refer to your
provider contract for details.
Consult Clinical Practice Guidelines in caring for patients
The National Committee for Quality
Assurance (NCQA) requires health plans to
regularly inform providers about the
availability of Clinical Practice Guidelines
(CPGs).
We base our CPGs and Preventive Service
Guidelines (PSGs) on nationally recognized
recommendations and peer-reviewed
medical literature. They are located on our
secure provider website under “Aetna
Support Center” then “Clinical Resources.”
•Preventive Service Guidelines
– Adopted 2/12
•Behavioral Health
-- Helping Patients Who Drink Too
Much – Adopted 2/12
--Treating Patients With Major Depressive
Disorder – Adopted 2/12
•Diabetes
•Heart Disease
- Treating Patients With Coronary Artery
Disease – Adopted 10/10
For a hard copy of PSGs, or a specific CPG,
call our Provider Service Center.
-- T
reating Patients With Diabetes
– Adopted 2/12
Keeping you and your patients informed
We want you to be aware of important program information that
can help you and your patients.
We integrate quality management and metrics into all we do. For
details on our quality management program, its goals and our
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Aetna OfficeLink Updates
progress toward those goals, log in to our secure provider
website and select “Aetna Support Center”, “Doing Business with
Aetna”, then “Quality Management Program”. Practices without
Internet access can request a paper copy by calling our Provider
Service Center.
Where to find UM, clinical policy support information
It’s easy to locate information about our
utilization management (UM) criteria,
Clinical Policy Bulletins (CPBs), Pharmacy
Clinical Policy Bulletins (PCPBs), and the
availability of our medical directors.
UM criteria
Patient Management staff applies
evidence-based, clinical criteria from
nationally recognized authorities as
guidance when rendering UM decisions.
They apply these criteria to the clinical
information collected. This process applies
to precertification, inpatient review and
retrospective review decisions.
•Choose “Policies & Guidelines” then
“Policy Bulletins” or “Determining
Coverage”
Center for a hard copy. For a PCPB, call
Pharmacy Management at
1-800-670-3566.
For a copy of the criteria upon which a
specific determination was based, call our
Provider Service Center.
Provider Service Centers
CPBs and PCPBs
To view the criteria used, click here for
Policy Bulletins and here for Determining
Coverage. Or:
CPBs and PCPBs explain and guide Aetna’s
determination of whether certain services,
medications or supplies are medically
necessary, experimental and
investigational or cosmetic. CPBs and
PCPBs can help you assess whether your
patient meets our clinical criteria for
coverage. They can also help you plan a
course of treatment before calling for
precertification, if required.
•Go to www.aetna.com and select
“Health Care Professionals”
To view CPBs, click here. If you don’t have
Internet access, call our Provider Service
•1-800-624-0756 for HMO-based
benefits plans, Medicare Advantage plans
and WA Primary Choice plan
•1-888-MDAetna (1-888-632-3862) for
all other plans
Medical director availability
Aetna medical directors are available
24 hours a day for specific UM issues.
Physicians can contact Patient
Management and Precertification staff at
the telephone number on the member’s ID
card. When only a Member Services
number is shown on the card, you will be
directed through either a phone prompt or
a Member Services representative.
HEDIS®* 2012 data collection underway
Aetna staff or our contracted
representatives are contacting your office
to collect medical record information from
our members’ visits in 2011. Our largest
contracted representatives include
MedAssurantTM and MediConnect.
Why this is necessary
Healthcare Effectiveness Data and
Information Set (HEDIS) data collection is a
nationwide, collaborative effort among
employers, health plans and physicians.
The goal is to monitor and compare health
plan performance as specified by the
National Committee for Quality Assurance
(NCQA).
As a Medicare Advantage organization, we
are required to submit member diagnosis
data to Centers for Medicare & Medicaid
Services (CMS) on an ongoing basis. Most
data is collected from claims and
encounters. We also gather some diagnosis
codes from member medical records.
We need your help
If contacted, we ask you to cooperate by
granting access to our members’ medical
records within the provided timeframe. Our
contracted representatives will work with
you and can provide options for sending in
medical records.
HIPAA guidelines
Our representatives serve Aetna in a role
that is defined and covered by the Health
Insurance Portability and Accountability
Act (HIPAA). Under HIPAA, Aetna is a
Covered Entity and our representatives’
role is as a Business Associate of a Covered
Entity. Providing medical record
information to us or our contracted
representatives complies with HIPAA
regulations.
* HEDIS is a registered trademark of the National
Committee for Quality Assurance.
MARCH 2012
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Southeast News
Results of our 2011 Medical Record Audit
Every two years, we conduct an audit to
assess how health care professionals are
complying with our medical record
documentation criteria.
We evaluated 23 documentation criteria
categories in the Southeast Region. Of
those, these three areas fell below the 85
percent compliance goal, and are being
targeted for improvement:
•Advance directives given by a patient
must be in a prominent part of the record
•Documentation of advance directives for
patients >18 years of age
•Age appropriate immunization record
present
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Aetna OfficeLink Updates
Our documentation criteria are in our
Health Care Professional Toolkit, located
on our secure provider website. Tools to
help improve medical record
documentation are also on our website and
include the following forms:
in the patient’s record (except for patients
under age 18). For Medicare patients, such
documentation is required by the Centers
for Medicare & Medicaid Services, for
which we must monitor participating
physician compliance.
•Adult Health Maintenance Form
Find advance directive forms for specific
states at www.aetnacompassionatecare.
com. If the state you practice in is not
listed, go to http://uslwr.com/formslist.
shtm for an applicable advance directive
form or for additional information.
•Medical History Form
•Pediatric Health and Immunization
Summary Forms
Advance directives
In your patients’ charts, you must
document whether a member has
prepared an advance directive. Aetna
Participating Practitioner Medical Record
Criteria require that advance directives
(executed or not) are in a prominent place
If you don’t have Internet access, you can
request a paper copy of the Toolkit by
calling our Provider Service Center.
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MARCH 2012
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PRSRT STD
U.S. POSTAGE
PAID
PERMIT NO. 12
ENFIELD, CT
CPE RW3H
151 Farmington Ave.
Hartford, CT 06156
Contact us at: [email protected]
Route this publication to:
Office Manager
Referral and Precertification Stafft
Business Staff
Front Desk Staff
Medical Records/Medical Assistants
Primary Care Physicians
Specialists
Physician Assistants/Clinical
Nurse Specialists
Nurses
“Aetna” is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. The Aetna companies
that offer, underwrite or administer benefit coverage include Aetna Better Health Inc., Aetna Health Inc., Aetna Health of California Inc, Aetna Dental
Inc., Aetna Dental of California Inc., Missouri Care, Incorporated, Aetna Life Insurance Company, Aetna Health Insurance Company of New York, and
Aetna Health Insurance Company. Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC.
New pharmacy programs can help with patient safety
Beginning April 1, 2012, many Aetna
members in commercial (non-Medicare)
plans will have access to two new clinical
pharmacy programs. We designed these
programs to help improve patient safety.
Maximum Dose: Through this program, we
will inform physicians about the maximum
daily dose suggested in product labeling.
We will identify Aetna member(s) who,
according to our records, may be on a dose
that exceeds this recommendation, and
notify their providers.
Length of Therapy: This program
identifies patients who have taken a drug
for longer treatment duration than
approved by the Food and Drug
Administration (FDA), or supported by
clinical evidence. We will remind physicians
about the defined length of therapy
suggested in the product labeling. We also
will identify Aetna member(s) who,
according to our records, may have
exceeded the suggested length of therapy,
and notify their providers.
With both programs, we will ask physicians
if they believe it is necessary to keep
prescribing the medication in the same
way, in light of the patient’s medical
condition, and to consider any risks or
benefits that continuing therapy may
represent.
The information and/or programs described in this newsletter may not necessarily apply to all services in this region. Contact your Aetna
network representative to find out what is available in your local network. Application of copayments and/or coinsurance may vary by plan
design. This newsletter is provided solely for your information and is not intended as legal advice. If you have any questions concerning
the application or interpretation of any law mentioned in this newsletter, please contact your attorney.
www.aetna.com
©2012 Aetna Inc.
48.22.808.1-Q1-SE (3/12)