AETNA HEALTH INC. (CONNECTICUT)Aetna • August 25th, 2009
Contract Type FiledAugust 25th, 2009Precertification Drug(s) ACTHAR HP DIFFERIN- for members greater than 35 years of age ERBITUX GABITRIL phenylephrine/promethazine/codeine- for members less than 6 years of age promethazine/codeine- for members less than 6 years of age RITUXAN TAZORAC- for members greater than 35 years of age TYSABRI VECTIBIX VIMPAT ZONEGRAN zonisamide