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
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
You are now leaving Aetna Better Health Premier Plan MMAI
You are now leaving Aetna Better Health Premier Plan MMAI. You are leaving our website and going to a non-Medicare/Medicaid website. If you do not intend to leave our site, please click Close.