Aetna prior authorization J3590

Aetna prior authorization for J3590: Alzheimer’s disease (precertification required for the drug and site of care): Leqembi SQ (lecanemab-irmb) — precertification required for Medicare

Code: J3590
Description: Alzheimer’s disease (precertification required for the drug and site of care): Leqembi SQ (lecanemab-irmb) — precertification required for Medicare
Description: Amtagvi (lifileucel,) — precertification required for the drug and site of care Contact National Medical Excellence
Description: Avzivi (bevacizumab-tnjn,)— precertification required for the drug and site of care effective October 1, 2026
Description: Botulinum toxins: Letybo (letibotulinumtoxinA-wlbg,)
Description: Cortrophin Gel (repository corticotropin)
Description: Enzyme replacement drugs (continued): Strensiq (asfotase alfa)
Description: Genglycos (pariglasgene brecaparvovec)— precertification required for drug effective October 1, 2026
Description: Granulocyte-colony stimulating factors: Ennumo (pegfilgrastim-pccg,) — precertification required effective
Description: Growth hormone: Skytrofa (lonapegsomatropin-tcgd) — precertification required for Medicare
Description: Hereditary angioedema agents: Dawnzera (Donidalorsen Sodium)
Description: Poherdy (pertuzumab-dpzb,,
Description: Immunologic agents: Enspryng (satralizumab) — precertification required for Medicare
Description: Immgolis Intri (golimumab-sldi,) — precertification required for the drug
Description: Immunnologics agents (continued): Tyenne (tocilizumab-aazg,) —precertification required for drug and
Description: Immunnologics agents (continued): Zimrixby (rituximab-cdxx,) — precertification required for drug and
Description: Injectable infertility drugs: Cetrotide (cetrorelix acetate)
Description: Kebilidi) — precertification required for the drug and site of care
Description: Kresladi (marnetegragene autotemcel)— precertification required for drug effective July 1, 2026 Contact National Medical Excellence
Description: Lantidra (donislecel-jujn,) Contact National Medical Excellence
Description: Muscular dystrophy drugs: (precertification required for the drug and site of care): Elevidys (delandistrogene moxeparvovec)
Description: Myalept (metreleptin) — precertification required for Commercial members only
Description: Ophthalmic injectables: Lumvoa (veligrotug-vvze,) —precertification required for the drug and site
Description: Ophthalmic injectables: Lytenava (bevacizumab-vikg,) — precertification required effective
Description: Ophthalmic injectables: Ranluspec (ranibizumab-hkdz,,
Description: Osteoporosis drugs: denosumab-bnht
Description: Osteoporosis drugs: denosumab-dssb
Description: Otarmeni (lunsotogene parvec-cwah) — precertification required effective July 1, 2026
Description: (garetosmab-grts,)
Description: penpulimab-kcqx
Description: (continued): Winrevair (sotatercept-csrk,)
Description: Revtorpyk (gedatolisib,)— precertification required effective September 1, 2026
Description: Rivfloza (nedosiran,) — precertification required for the drug and site of care
Description: Saphnelo SC (Anifrolumab-fnia) — precertification required for the drug and site of care effective July 1, 2026.
Description: Sarclisa Escena SC (isatuximab-irfc) — precertification required effective September 1, 2026
Description: Somatostatin agents: Signifor (pasireotide) — precertification required for Commercial
Description: Somatostatin agents: Somavert (pegvisomant) — precertification required for Commercial
Description: Tregzi (T cells-vldq,)— precertification required effective August 1, 2026
Description: Tudriqev (vusolimogene oderparepvec) — precertification required effective October 1, 2026 Contact National Medical Excellence
Description: Vyjuvek (beremagene geperpavec,)
Description: Zanvastro (zilganersen,)— precertification required effective October 1, 2026
Source: Participating provider precertification list for Aetna, Pg 19 Original policy
Source: Participating provider precertification list for Aetna, Pg 20 Original policy
Source: Participating provider precertification list for Aetna, Pg 20 Original policy
Source: Participating provider precertification list for Aetna, Pg 21 Original policy
Source: Participating provider precertification list for Aetna, Pg 21 Original policy
Source: Participating provider precertification list for Aetna, Pg 22 Original policy
Source: Participating provider precertification list for Aetna, Pg 23 Original policy
Source: Participating provider precertification list for Aetna, Pg 23 Original policy
Source: Participating provider precertification list for Aetna, Pg 24 Original policy
Source: Participating provider precertification list for Aetna, Pg 24 Original policy
Source: Participating provider precertification list for Aetna, Pg 25 Original policy
Source: Participating provider precertification list for Aetna, Pg 25 Original policy
Source: Participating provider precertification list for Aetna, Pg 26 Original policy
Source: Participating provider precertification list for Aetna, Pg 26 Original policy
Source: Participating provider precertification list for Aetna, Pg 26 Original policy
Source: Participating provider precertification list for Aetna, Pg 27 Original policy
Source: Participating provider precertification list for Aetna, Pg 27 Original policy
Source: Participating provider precertification list for Aetna, Pg 27 Original policy
Source: Participating provider precertification list for Aetna, Pg 27 Original policy
Source: Participating provider precertification list for Aetna, Pg 28 Original policy
Source: Participating provider precertification list for Aetna, Pg 28 Original policy
Source: Participating provider precertification list for Aetna, Pg 29 Original policy
Source: Participating provider precertification list for Aetna, Pg 29 Original policy
Source: Participating provider precertification list for Aetna, Pg 29 Original policy
Source: Participating provider precertification list for Aetna, Pg 29 Original policy
Source: Participating provider precertification list for Aetna, Pg 29 Original policy
Source: Participating provider precertification list for Aetna, Pg 30 Original policy
Source: Participating provider precertification list for Aetna, Pg 30 Original policy
Source: Participating provider precertification list for Aetna, Pg 31 Original policy
Source: Participating provider precertification list for Aetna, Pg 31 Original policy
Source: Participating provider precertification list for Aetna, Pg 32 Original policy
Source: Participating provider precertification list for Aetna, Pg 32 Original policy
Source: Participating provider precertification list for Aetna, Pg 32 Original policy
Source: Participating provider precertification list for Aetna, Pg 32 Original policy
Source: Participating provider precertification list for Aetna, Pg 32 Original policy
Source: Participating provider precertification list for Aetna, Pg 32 Original policy
Source: Participating provider precertification list for Aetna, Pg 33 Original policy
Source: Participating provider precertification list for Aetna, Pg 33 Original policy
Source: Participating provider precertification list for Aetna, Pg 33 Original policy
Source: Participating provider precertification list for Aetna, Pg 34 Original policy

Aetna prior authorization