2013 Aetna Medicare Prescription Drugs that Require Step Therapy ...

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FORTEOProducts AffectedForteo INJ 600MCG/2.4ML,750MCG/3MLDetailsCriteriaA documented trial of one month of generic alendronate or ibandronate12
INDEXBBd Insulin Syringe Safetyglide/1ml/29g X 1/2 ... 10Bd Insulin Syringe Ultrafine/0.3ml/31g X 5/16 .. 10Bd Insulin Syringe Ultrafine/0.5ml/30g X 1/2 .... 10Bd Insulin Syringe Ultrafine/1ml/31g X 5/16 ..... 10Bd Pen Needle/ultrafine/29g X 12.7mm ............. 10Brintellix ............................................................... 3CChantix ................................................................ 11Chantix Continuing Month Pak .......................... 11Chantix Starting Month Pak ................................ 11EElidel ..................................................................... 8FFanapt .................................................................... 4Fanapt Titration Pack ............................................ 4Fazaclo .................................................................. 4Forteo .................................................................. 12GGabitril .................................................................. 1Geodon .................................................................. 4LLamictal Odt .......................................................... 2Lidocaine................................................................ 7Lidoderm ................................................................ 7NNucynta .................................................................. 5RRanexa.................................................................... 6SSabril ...................................................................... 1Sandostatin Lar Depot ............................................ 9Somatuline Depot................................................... 9Somavert ................................................................ 9VV-go 20 ................................................................ 10V-go 30 ................................................................ 10V-go 40 ................................................................ 10Vimpat.................................................................... 113
Page 4: ATYPICAL ANTIPSYCHOTICProducts Affe
Page 7 and 8: LIDODERMProducts Affected Lidocaine
Page 9 and 10: SOMATOSTATIN ANALOGSProducts Affect
Page 11: SMOKING CESSATIONProducts AffectedC

2013 Aetna Medicare Prescription Drugs that Require Step Therapy ...

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