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Hospital Access Program Aetna Directory Aetna Monthly HFS/IHA reports: Fabian Camarena, Corporate Finance CamarenaF@aetna.com Aetna Medicaid 1 South Wacker Drive Chicago, IL 60606 P 312 821 0581 F 860 902 8046 Eric Campbell, Corporate Compliance CampbellE2@aetna.com Aetna Med

TransitionofCare-English-IL

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Step Therapy Criteria

2016 Step Therapy Criteria Effective: 04/01/2016 Updated 04/2016 1 ANTIDEPRESSANTS Products Affected • Brintellix • Desvenlafaxine Er • Emsam • Fetzima • Fetzima Titration Pack • Pristiq TB24 25MG Details Criteria A documented trial of one month each of two of

Prior Authorization Criteria Form

9/01/2013 Prior Authorization AETNA BETTER HEALTH OF ILLINOIS Oxycontin (IL88) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign and date. Fax signed forms to Aetna Better Health Illinois at 1-855-684-5250. Please co

Reference Number: C6576-A/ Effective Date: 02/22/2017 1 Prior Authorization AETNA BETTER HEALTH ILLINOIS (MEDICAID) Forteo (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign and date. Fax signed form

MMP PA Criteria_Look Up Tool_05 01 2017

2017 Prior Authorization Criteria Effective: 05/01/2017 Updated 05/2017 ACTHAR GEL Products Affected • H.p. Acthar PA Criteria Criteria Details Covered Uses All medica

Prior Authorization Criteria Form

Prior Authorization 08/26/2015 AETNA BETTER HEALTH OF ILLINOIS FAMILY HEALTH PLAN (MEDICAID) Acamprosate (IL88) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign and date. Fax signed forms to Aetna Better Health Ill

Reference Number: C7072-A / Effective Date: 08/19/2017 1 Pharmacy Prior Authorization AETNA BETTER HEALTH ILLINOIS FAMILY HEALTH PLAN (MEDICAID) Insulin Pens (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review informati

How your health insurance works Important information about you and your membership in Aetna Better Health of Illinois (Aetna Better Health). As a member of Aetna Better Health, you should know your rights, how to appeal a decision and other information that is essential to being an active partner

Aetna Better Health Illinois Premier Plan October 2015 Formulary Updates Generics Added DACARBAZINE INJ 100MG (PA required) DOCETAXEL INJ 20MG/2ML (PA required) ESOMEPRAZOLE CAP 20 MG ESOMEPRAZOLE CAP 40 MG Brands Added BEXAROTENE CAP 75MG (PA required) DOCETAXEL INJ 160/16ML (PA req