Changes to our National Precertification List (NPL)
This update applies to both our commercial and Medicare members.
Effective March 1, 2023, we will no longer require precertification for the site of service for vitrectomy procedures.
The following new-to-market drugs require precertification:
- Lutrate® (leuprolide acetate) — precertification is required starting March 1, 2023. This drug is part of the Luteinizing hormone-releasing hormone (LHRH) agents category.
- Lanreotide (cipla) — precertification is required starting March 1, 2023. This drug is part of the somatostatin agents category.
- Bortezomib (Dr. Reddy’s) — precertification is required starting March 1, 2023.
- Bortezomib (Fresenius Kabi) — precertification is required starting March 1, 2023.
- Bortezomib (Hospira) — precertification is required starting March 1, 2023.
- Elahere™ (mirvetuximab soravtansine-gynx) — precertification is required starting March 1, 2023.
- Imjudo® (tremelimumab) — precertification is required starting March 1, 2023.
- Tzield™ (teplizumab-mzwv) — precertification is required starting March 17, 2023.
- Vivimusta™ (bendamustine hydrochloride) — precertification is required starting March 17, 2023.
- Hemgenix® (etranacogene dezaparvovec-drlb) — precertification is required starting March 17, 2023. This drug is part of the blood clotting factors category.
The following drugs require precertification effective July 1, 2023:
- Prolia® (denosumab) — this drug is part of the osteoporosis drugs category.
- Stelara SC® (ustekinumab) — this drug is part of the immunologic agents category.
- Korsuva® (difelikefalin)
- Lutathera® (lutetium Lu 177 dotatate) — this drug is part of the radiopharmaceutical drugs category.
- Metastron (Strontium-89 Chloride injection) — this drug is part of the radiopharmaceutical drugs category.
- Pluvicto™ (Lutetium Lu 177 vipivotide tetraxetan) — this drug is part of the radiopharmaceutical drugs category.
- Zevalin (ibritumomab tiuxetan) — this drug is part of the radiopharmaceutical drugs category.
Submitting precertification requests
Be sure to submit precertification requests at least two weeks in advance. To save time, request precertification online. Doing so is fast, secure and simple.
You can submit most requests online through our Availity provider portal.* Or you can use your practice’s Electronic Medical Record (EMR) system if it’s set up for electronic precertification requests. Use our “Search by CPT code” search function on our precertification lists page to find out if the code requires precertification.
Learn more about precertification.
Are you asking for precertification on a specialty drug for a commercial or Medicare member? Then submit your request through Novologix®, also available on Availity®.
Not registered for Availity? Go to Availity to register and learn more.
You can always find this information on our Availity provider portal
You can also use our Code Edit Lookup tools on Availity. Just go to
Payer Space > Applications > Code Edit Lookup Tools.
And keep your Aetna® provider ID number handy to access them.