12/16/2025

Aetna

Helpful Links

• OfficeLink Updates December
• 2025 Aetna Pharmacy Drug Guide 
• Participating Provider Precertification List for Aetna 

Changes to our National Precertification List (NPL)
These changes apply to our commercial and Medicare members, unless otherwise noted.

Effective January 1, 2026, we’ll require precertification for the following:

• Electrophysiological (EP) study (93654)
• Yondelis (trabectedin, J9352)
• Docivyx (docetaxel, J9172) - Medicare members only

Changes to Commercial Drug Lists Begin on January 1, 2026
Find out about drug list changes and how to request drug prior authorizations (PAs).

On January 1, 2026, we’ll update our pharmacy drug lists. Changes may affect all drug lists, precertification, step therapy, and quantity limit programs. You’ll be able to view the changes here Formularies and Pharmacy Clinical Policy Bulletins

Ways to request a drug PA

• Submit your PA through CoverMyMeds.
• For requests for non-specialty drugs, call 1-800-294-5979 (TTY: 711). Or fax your authorization request form to 1-888-836-0730.
• For requests for drugs on the Aetna Specialty Drug List, call 1-866-814-5506 (TTY:711) or go to our Forms for Health Care Professionals page and scroll down to the Specialty Pharmacy Precertification (commercial) drop-down menu. If the specific form you need is not there, scroll to the end of the list and use the generic Specialty Medication Precertification Request Form. Once you fill out the relevant form, fax it to 1-866-249-6155.

Medications on the Aetna Drug Guide, precertification, step-therapy, and quantity limits lists are subject to change.

More information
For more information, refer to the Contact Aetna page and select the Providers tab.

Aetna Smart Compare is Coming in 2026

The Aetna Smart Compare program
Aetna Smart Compare is a provider designation program that evaluates our participating providers, identifying those that meet higher standards of quality and cost-effectiveness. The national program began in 2021 and has continued to expand by specialty.

Evaluation notification
In late 2025, we’ll notify the physicians we’ve evaluated. These physicians can go to our Aetna Smart Compare Designation page and refer to the Aetna Smart Compare Methodology Guide to access the latest standards and measurements applicable to the evaluation period.

Evaluation period for 2026
The 2026 designations for Aetna Smart Compare evaluate claims data from 2023 and 2024.

How to dispute a designation
Physicians will have an opportunity to dispute the designation before it’s published through a process that includes the following protections:

• We’ll provide at least 45 days’ written notice of the designation, including the methodologies, data, and all other information we used to arrive at the designation.
• Physicians can request a fair reconsideration proceeding within 45 days of receiving the written notice.
• All reconsiderations begun in the first 45 days may lead to reversing our decision for your practice, regardless of the length of our exchange.