Aetna Medicare Part B Drug Criteria

Aetna Medicare covers specific drug treatments for metastatic breast cancer, non-small cell lung cancer, and pancreatic adenocarcinoma, provided they are combined with other agents and meet certain criteria such as previous chemotherapy and specific disease progression scenarios. Key requirements for coverage include documentation of diagnosis, treatment history, and compliance with FDA indications, while limitations specify that treatments are not covered for patients ineligible for chemotherapy or for preventive purposes. Authorization for therapy may be granted for up to six months, contingent on ongoing treatment with the requested drug and adherence to Medicare’s compendium guidelines for off-label use.

"Indicated for the treatment of metastatic breast cancer in combination with other agents."

Sign up to see full coverage criteria, indications, and limitations.