Aetna introduces RX prior authorization

Aetna has a number of alerts in place to keep our members posted on their status (e.g., dental, COB, ENI, etc.) to help reduce calls into the call center, thereby reducing costs and improving member experience, and to meet member disclosure requirements. The purpose is to keep members informed of any additional expense they may need to incur. 

What’s changing: Starting 7th May, Aetna will be adding a new alert – Rx prior authorization.  

• The new alert will inform members when an Rx prior auth is submitted by their doctor and when an auth is approved or denied. 
• Provide guidance, consistent with regulatory requirements, on next steps when a claim is denied. 
• Help prevent members from resubmitting claims and causing additional claim denials or potential overturned claims. 
• The new alerts program will keep your plan’s costs down by reducing calls into the call center and improving member experience and satisfaction.  

Aetna will be monitoring the alerts program for member feedback for continuous improvement opportunities.  For more information, we kindly invite you to review the Aetna Flyer on Rx prior authorization.