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OfficeLink Updates - November 2025 notices and reminders (PDF)
Aetna·ME, VT, WA, TX · Oncology, Reproductive Medicine, Psychiatry +2 more·Newsletter
Effective date
Nov 1, 2025
We identified it
Jun 19, 2026
Summary
Aetna is implementing multiple prior authorization changes for specialty drugs and procedures, removing precertification requirements for artificial insemination procedures, and requiring valid CPT/HCPCS codes for behavioral health services. Key changes take effect at various dates from November 2025 through February 2026.
Action Required
Immediately: Update prior authorization requirements in billing system for new specialty drugs (Lynozyfic IV, Ustekinumab-aauz) effective November 1, 2025, and Dawnzera effective November 13, 2025. By January 1, 2026: Remove prior authorization requirements for artificial insemination codes 58321, 58322, 58323, and add precertification requirement for Keytruda Qlex. By February 1, 2026: Ensure all behavioral health services on bill types 86x and 89x include valid CPT/HCPCS codes. Submit all precertification requests at least two weeks in advance through Availity portal.