Applications and forms for health care professionals in the Aetna network and their patients can be found here. Browse through our extensive list of forms and find the right one for your needs.

Prior Authorization/Precertification* Request for Prescription Medications Submit your request online at: https://www.availity.com Visit www.aetna.com/formulary to access our Pharmacy …

Authorization may be granted when the requested drug will be used with a reduced-calorie diet AND increased physical activity to treat moderate to severe obstructive sleep apnea (OSA) in …

Prior Authorization (PA) This Zepbound PA checklist is intended to highlight important categorical information often considered in patient coverage decisions. Actual coverage requirements will …

Please contact CVS/Caremark at 1-888-413-2723 with questions regarding the prior authorization process. When conditions are met, we will authorize the coverage of the medication.

Formulary Exception/Prior Authorization Request Form ... Expedited/Urgent Review Requested: By checking this box and signing below, I certify that applying the standard review time frame …

If a form for the specific medication cannot be found, please use the Global Prior Authorization Form. California members please use the California Global PA Form. To access other state …

WEIGHT LOSS MEDICATIONS PRIOR APPROVAL REQUEST drugs. Please complete the patient portion, and have the prescribing physician complete the Send completed form to: …

Follow the patient’s plan requirements when requesting Zepbound; otherwise, treatment may be delayed. For guidance completing the initial Prior Authorization for a patient, see the …

NOTE: The prescribing physician (PCP or Specialist) should, in most cases, complete the form. Please provide the physician address as it is required for physician notification. Fax the …

May 16, 2024 · You only need prior authorization for Zepbound if your insurance covers Zepbound and you want to reduce your out-of-pocket cost. Call the customer service number on the back …

Aug 1, 2024 · See our precertification lists or utilize our CPT code lookup to see whether a procedure or service requires prior approval. Discover the Aetna difference.

To initiate the Aetna Zepbound prior authorization process, you'll need to submit a prior authorization request through the Aetna website or the Availity Provider Portal. Aetna …

Nov 1, 2024 · Check your insurance plan’s drug formulary to find out if Zepbound is covered and if prior authorization is required before coverage is approved by logging into the Aetna member …

Before approving Zepbound coverage, most insurance plans will require what’s known as a prior authorization (PA) form—a coverage request your doctor submits on your behalf with …

Q14. Zepbound being prescribed by or in consultation with a sleep specialist, pulmonologist or endocrinologist? er hour? Documentation of baseline polysomnography or recording time must …

NOTE: The prescribing physician (PCP or Specialist) should, in most cases, complete the form. Please provide the physician address as it is required for physician notification. Fax the …

Feb 25, 2025 · Launching the Zepbound Self Pay Journey Program, which reduces the price of the 7.5 mg ($599) and 10 mg ($699) doses to $499 per month at first fill and refills that occur …

This form should be used when a healthcare provider prescribes Zepbound for a patient requiring prior authorization from their insurance. It is essential when patients have insurance that …