Aetna Specialty Documents and Forms

Find the documents and forms you need to request specialty medications.

Aetna Specialty Precertification forms

• Abatacept (Orencia ® ) Precertification Request Form (PDF, 307 KB)
• Adalimumab (Humira ® ) Precertification Request Form (PDF, 651 KB)
• Alefacept (Amevive ® ) Precertification Request Form (PDF, 317 KB)
• Alpha 1 Antitrypsin Inhibitor Therapy Precertification Request Form (PDF, 579 KB)
• Anakinra (Kineret ® ) Precertification Request Form (PDF, 291 KB)
• Antiemetic Injectable Medication Precertification Request Form (PDF, 337 KB)
• Belimumab (Benlysta®) Injectable Medication Precertification Request (PDF, 366 KB)
• Botulinum Toxins Medication Precertification Request (PDF, 755 KB)
• Brentuximab vedotin (Adcetris®) Injectable Medication Precertification Request (PDF, 293 KB)
• Cabazitaxel (Jevtana®) Injectable Medication Precertification Request (PDF, 303 KB)
• Certolizumab (Cimzia ® ) Precertification Request Form (PDF, 365 KB)
• Cetuximab (Erbitux) Injectable medication precertification request form (PDF, 281 KB)
• Denosumab (Prolia, Xgeva) Medication Precertification Request (PDF, 638 KB)
• Eculizumab (Soliris ® ) Medication Precertification Request Form (PDF, 338 KB)
• Enzyme Replacement Precertification Request Form (PDF, 450 KB)
• EPO/Dialysis medication precertification request form (PDF, 739 KB)
• Etanercept (Enbrel ® ) Precertification Request Form (PDF, 414 KB)
• Golimumab (Simponi ® ) Precertification Request Form (PDF, 600 KB)
• Growth Hormone Medication Request Forms:
  • Adult Growth Hormone Medication Request Form (PDF, 502 KB)
  • Pediatric Growth Hormone Medication Request Form (PDF, 443 KB)
  • Female Precertification Request Form (PDF, 468 KB)
  • Male Precertification Request Form (PDF, 420 KB)

  Aetna Specialty Pharmacy offers specialized care for patients with complex chronic conditions.

  Aetna Specialty Pharmacy forms

  • General Medication Request Form (PDF,1 MB)
  • Crohn's/Ulcerative Colitis Medication Request Form (PDF, 349 KB)
  • Enzyme Replacement Medication Request Form (PDF, 541 KB)
  • Growth Hormone Medication Request Form (PDF, 239 KB)
  • Hemophilia Medication Request Form (PDF, 591 KB)
  • Hepatitis C Medication Request Form (PDF, 516 KB)
  • HIV/AIDS Medication Request Form (PDF, 591 KB)
  • Immune Globulin Medication Request Form (PDF, 520 KB)
  • Infertility Medication Request Form (PDF, 626 KB)
  • Osteoporosis Medication Request Form (PDF, 416 KB)
  • Psoriasis Medication Request Form (PDF, 166 KB)
  • Rheumatoid/Psoriatic/Juvenile Arthritis and Ankylosing Spondylitis Medication Request Form (PDF, 400 KB)
  • Synagis Medication Request Form (PDF, 587 KB)
  • Synagis® Reorder Form (PDF, 544 KB)
  • Vivitrol Reorder Form (PDF, 530 KB)
  • Transplant Medication Request Form (PDF, 569 KB)
  • Viscosupplementation Medication Request Form (PDF, 520 KB)

  Physician welcome materials

  • Aetna Specialty CareRx drug lists
  • Precertification list
  • Infused and injected medications quick guide (PDF, 173 KB)
  • Most frequently prescribed medications (PDF, 465 KB)
  • Physician satisfaction questionnaire (PDF, 728 KB)
  • Physician welcome brochure (PDF, 1.4 MB)

  Tools for Health Care Professionals

  • Manage Claims
  • Find a Doctor or Hospital
  • Find a Document or Form
  • Search Drug Formularies
  • Contact Aetna