Intravenous Iron Therapy (CPB 0575, reviewed 2026-07-01)

REQUIREMENTS: - Immediately: All Aetna participating providers and billing teams must implement precertification requirements for Feraheme, Ferrlecit, Injectafer, Monoferric, and Venofer before claims submission. Special note: Ferrlecit and Venofer precertification becomes effective August 1, 2026. - Before claim submission: Billing team must verify member has documented contraindication, intolerance, or ineffective response to generic ferumoxytol, generic iron sucrose, generic sodium ferric gluconate, or INFeD (iron dextran) before authorizing branded IV iron products. For peritoneal dialysis and NDD-CKD indications, verify failure of generic ferumoxytol, generic iron sucrose, or generic sodium ferric gluconate specifically. - Before authorizing: Verify labeled indication matches the member's diagnosis. If lower-cost alternative lacks the required labeled indication, then authorize the branded product with required indication. - Precertification process: Contact (866) 752-7021 or fax (888) 267-3277. Submit Statement of Medical Necessity (SMN) precertification forms per Specialty Pharmacy Precertification requirements. - Update billing software: Configure system to require and flag precertification for all five branded IV iron products in applicable plan designs. - Consequence of inaction: Claims for branded IV iron products submitted without precertification or without documented failure of generic alternatives will be denied as not medically necessary.