Aetna · Identified Oct 1, 2026Medium impact
Drug-Eluting Stents (CPB 0621, reviewed 2026-09-23)
Aetna considers FDA-approved everolimus-, paclitaxel-, sirolimus-, zotarolimus- and ridaforolimus-eluting coronary stents medically necessary for members with acute coronary syndrome, angina pectoris (stable ischemic heart disease) or silent ischemia who can tolerate anti-platelet or anti-coagulant therapy and who have one of these findings: coronary stenosis of 50% or greater in the left main coronary artery, angina that is refractory, contraindicated or intolerant to optimal medical therapy with 70% or greater stenosis in one or more coronary arteries, or angina that is refractory, contraindicated or intolerant to optimal medical therapy with coronary stenosis greater than 50% and fractional flow reserve (FFR) of 0.80 or less. FDA-approved drug-eluting stents are also covered for intra-coronary stent re-stenosis and for coronary lesions in Kawasaki disease. For peripheral arteries, the Eluvia system is covered for primary treatment of superficial femoral artery and proximal popliteal artery disease, and the Zilver PTX stent is covered for primary treatment of femoro-popliteal artery disease. Antibody-coated coronary stents, biodegradable polymer drug-eluting stents, drug-eluting ureteral stents for kidney stones, and drug-eluting stents for all other listed indications, including coronary artery aneurysms, vein graft stenosis, intracranial atherosclerotic stenosis, myocardial bridging and the Eluvia system for iliac artery stenosis, are considered experimental, investigational or unproven because their effectiveness has not been established.