Coverage policy changing for hormone, thyroid compounds 

Effective October 1, 2007, Aetna will no longer cover the following bioidentical hormones and thyroid compounded drugs:

More information is available in Medical Clinical Policy Bulletins (CPBs) #0388 and #0608 – Complementary and Alternative Medicine and Salivary Hormone Tests, respectively – as well as Pharmacy CPB Compounded Drug Products, through Aetna's secure provider website.

Medical necessity coverage criteria: Aetna will consider compounded drug products medically necessary only if all of the following criteria are met:

• The product contains at least one prescription ingredient.

• The prescription ingredient is approved by the Food and Drug Administration (FDA) for medical use in the United States.

• The compounded product is not a copy of a commercially available FDA approved drug product.

• The safety and effectiveness of use for the prescribed indication is supported by FDA approval or adequate medical and scientific evidence in the medical literature.
  
  

Please review the Aetna Preferred Drug List (formulary) at www.aetna.com/formulary for alternatives covered under your patients’ specific benefits plans, or talk with them about FDA-approved alternatives.