Secure Site Log In
| Medical Professionals Log In |
 |
| Register | Take a Tour | |
| Dental Professionals Log In |
|
| Register | |
| Pharmacy Professionals Log In |
|
Why Register?
- Secure 24/7 access
- Submit claims electronically
- Get claim payment information through ERA/EFT
- Learn about important Aetna announcements
Aetna Specialty Pharmacy Documents and Forms
Find the documents and forms you need to request specialty medications.
Aetna Specialty Pharmacy offers specialized care for patients with complex chronic conditions.
Aetna Specialty Pharmacy forms
- General medication request form
(PDF, 466 KB) - Antiemetic Injectable Medication Precertification Request Form (PDF, 493 KB)
- Belimumab (Benlysta®) Injectable Medication Precertification Request (PDF, 487 KB)
- Cabazitaxel (Jevtana®) Injectable Medication Precertification Request (PDF, 521 KB)
- Cetuximab (Erbitux) Injectable medication precertification request form (PDF, 111 KB)
- Crohn's medication request form (PDF, 239 KB)
- Denosumab (XGEVA) Injectable Medication Precertification Request (PDF, 731 KB)
- Enzyme Replacement Precertification Request Form (PDF, 189 KB)
- EPO/Dialysis medication precertification request form (PDF, 115 KB)
- Growth Hormone Medication Request Form (PDF, 312 KB)
- Hemophilia Medication Request (PDF, 88 KB)
- Heparin medication request form (PDF, 79 KB)
- Hereditary Angioedema Medication Precertification Request Form (PDF, 104 KB)
- HIV/AIDS patient referral/medication request form (PDF, 103 KB)
- Hydroxyprogesterone Caproate (Makena®) Medication Precertification Form (PDF, 793 KB)
- Infertility Medication Precertification Request Form (PDF, 176 KB)
- Ipilimumab (Yervoy®) Injectable Medication Precertification Request Form (PDF, 488 KB)
- IVIG therapy medication request form (PDF, 279 KB)
- Multiple Sclerosis Medication Precertification request form (PDF, 536 KB)
- Omalizumab (Xolair®) Medication Precertification Form (PDF, 121 KB)
- Oral Oncology medication request form (PDF, 90 KB)
- Osteoporosis Precertification Request Form (PDF, 540 KB)
- Panitumumab (Vectibix) Injectable medication precertification request form (PDF, 100 KB)
- Pegloticase (Krystexxa®) Injectable Medication Precertification Request Form (PDF, 738 KB)
- Provenge medication precertification request form (PDF, 546 KB)
- Pulmonary Arterial Hypertension Precertification Request Form (PDF, 99 KB)
- RA Medication Request Form (PDF, 160 KB)
- Repository Corticotropin (H.P Acthar Gel) Injectable medication precertification request form (PDF, 120 KB)
- Rheumatoid Arthritis (Rituxan) medication precertification request form (PDF, 150 KB)
- Eculizumab (Soliris®) Medication Precertification Request Form (PDF, 92 KB)
- Synagis® reorder form (PDF, 22 KB)
- Synagis® statement of medical necessity form (PDF, 275 KB)
- Transplant Medication Request Form (PDF, 150 KB)
- Viscosupplementation Injectable Medications Precertification Request Form (PDF, 134 KB)
Physician welcome materials
- Aetna Specialty CareRx drug lists
- Precertification list
- Infused and injected medications quick guide (PDF, 84 KB)
- Most frequently prescribed medications (PDF, 501 KB)
- Physician satisfaction questionnaire (PDF, 60 KB)
- Physician welcome brochure (PDF, 276 KB)
Tools for Health Care Professionals
- Manage Claims
- Find a Doctor or Hospital
- Find a Document or Form
- Search Drug Formularies
- Contact Aetna
Aetna.com
- Site Map
- Frequently Asked Questions
- Glossary
- Member Services
- Member Guidelines
- Legal Notices
- Web Privacy Statement
FEEDBACK
Tools for Health Care Professionals
- Manage Claims
- Find a Doctor or Hospital
- Find a Document or Form
- Search Drugs Formularies
- Contact Aetna
