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伊利诺伊州首选药物清单2025年3月
* - 感染的药物........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... *Antimycobacterial Agents* - Drugs For Infections ..........................................................................75 *Antineoplastics And Adjunctive Therapies* - Drugs For Cancer ...................................................76 *Antiparkinson And Related Therapy Agents* - Drugs For The Nervous System ......................... 87 *Antipsychotics/Antimanic Agents* -神经系统的药物............................................................................................................................................................................................................................................................................................................... ......................................................................................................................................................................................................................................................................................................................................钙通道阻滞剂 * - 心脏的药物.............................................................................................................* - 心脏的药物........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... ..........................................................................................................................................................................................................................................................................................................................................................................................................................-激素.....................................................................................................................................................................................皮肤....................................................................................................................................................................................................................................................................................................................................................................................................................................................... ............................................................................................................................................................................................. 156
Aetna Better Health of Virginia 处方指南 2025 年 2 月
目录 *注意力缺陷多动障碍/抗嗜睡症/抗肥胖/厌食症*......................................................................................................................3 *替代药物*...................................................................................................................................................4 *氨基糖苷类*...................................................................................................................................................10 *镇痛药 - 抗炎*......................................................................................................................................................11 *镇痛药 - 非麻醉性*.........................................................................................................................................................15 *镇痛药 - 阿片类*.........................................................................................................................................................22 *雄激素-合成代谢*.........................................................................................................................................................25 *肛肠及相关产品*.............................................................................................................................................25 *抗酸药*.............................................................................................................................................................27 *驱虫药*.............................................................................................................................................................30 *抗心绞痛药药物*................................................................................................................................................31 *抗焦虑药物*...................................................................................................................................................31 *抗心律失常药物*...................................................................................................................................................32 *抗哮喘及支气管扩张药物*......................................................................................................................................32 *抗凝剂*......................................................................................................................................................36 *抗惊厥药物*....................................................................................................................................................36 *抗抑郁药物*....................................................................................................................................................39 *抗糖尿病药物*......................................................................................................................................................40 *止泻药/益生菌剂*................................................................................................................................................ 45 *解毒剂和特异性拮抗剂*.................................................................................................................................... 49 *止吐药*...................................................................................................................................................................49 *抗真菌剂*...................................................................................................................................................................51 *抗组胺剂*......................................................................................................................................................................51 *抗高脂血症剂*......................................................................................................................................................56 *抗高血压剂*......................................................................................................................................................57 *抗感染剂 - 杂项*................................................................................................................................................60 *抗疟药*................................................................................................................................................................... 61 *抗肌无力/胆碱能药物*................................................................................................................................................... 61 *抗分枝杆菌剂*...................................................................................................................................................62 *抗肿瘤药物和辅助疗法*................................................................................................................................62 *抗帕金森病和相关治疗药物*.................................................................................................................... 66 *抗精神病药/抗躁狂药物*....................................................................................................................................67 *防腐剂和消毒剂*.......................................................................................................................................70 *抗病毒药物*.......................................................................................................................................................72 *β受体阻滞剂*.......................................................................................................................................77 *钙通道阻滞剂*....................................................................................................................................77 *强心剂*....................................................................................................................................................7................................................................................................ 79 *心血管药物 - 杂项*......................................................................................................................................79 *头孢菌素*...................................................................................................................................................79 *化学品*...................................................................................................................................................80 *避孕药*......................................................................................................................................................81 *皮质类固醇*......................................................................................................................................................90 *咳嗽/感冒/过敏*.............................................................................................................................................91 *皮肤病学*......................................................................................................................................................109 *诊断产品*......................................................................................................................................................135 *膳食产品/膳食管理产品*................................................................................................................................136 *消化助剂*......................................................................................................................................................136.................... 109 *诊断产品*................................................................................................................................................135 *膳食产品/膳食管理产品*........................................................................................................................136 *消化助剂*................................................................................................................................................136.................... 109 *诊断产品*................................................................................................................................................135 *膳食产品/膳食管理产品*........................................................................................................................136 *消化助剂*................................................................................................................................................136
01-01-2025 AETNA HEALTHFUND™AETNACOHIECTE®POSII-ASC
AetnaHealthFund®功能健康基金滚动您的Healthfund剩余的任何东西都将滚入您的2025 HealthFund。HealthFund共同保险100％这是HealthFund支付您获得的服务的百分比。HealthFund涵盖了合格的医疗费用，最高为全额。Healthfund管理局Healthfund将为您的免赔额和共同保险付费。遇到可扣除额后，您的健康计划就会提供覆盖范围。如果您的Healthfud有余额，它将支付您的费用（即您的共同保险），直到达到自付限额为止。它继续这样做，直到剩下的保健费。HealthFund不会支付以下费用：•超过合理且习惯的限制的费用•任何计划限制的成本•任何未覆盖的费用•服务以100％覆盖，无扣除。这些是由计划支付的。处方药费用您的药房费用不是由您的Healthfud支付的。计划功能在网络内网络外福利限制 - 某些服务或耗材每年有限制。每年可能有最大数量的访问或天数或美元限额。在这种情况下，收益年将于1月1日开始（除非另有说明）。请参阅您的计划文件以了解更多信息。可扣除额（每个日历年）每个人$ 9,150 $ 9,150，每个家庭$ 6,300 $ 6,300 $ 18,300每个家庭承保的费用加起来，同时可扣除您的网络内和网络外部。处方药成本不计入免赔额。除非另有说明，否则您必须在计划开始支付福利之前首先满足免赔额。您支付的某些医疗服务所支付的金额（成本分配）不计入您的免赔额。有关详细信息，请参阅您的计划文件。您的家人将有一种自付额。，当几个家庭成员的费用加起来可扣除时，您将遇到它。没有人必须支付的费用超过个人扣除额。成员共同保险覆盖100％您支付的40％适用于所有费用，但如前所述。自付限额（每个日历年）
aetna的弗吉尼亚州健康状况良好
• To help ease the burden of chart review for many NCQA HEDIS performance measures • To enable more effective monitoring of quality and service delivery within a physician practice • To allow providers to report services and/or values based on nationally recognized, evidence-based guidelines for improving the quality of patient care • To capture data that ICD 10 codes and CPT c ategory I codes do not , relay ing important information related to health outcome measures • To enable组织全年监视关键措施的内部绩效，而不是每年一次
SHBP退休人员牙科费用计划（DEP/PPO）-Aetna nj
主要的修复服务包括那些恢复现有牙齿的服务。仅当无法使用汞合金，丙烯酸，合成瓷器或复合填充恢复牙齿恢复牙齿时，才能使用这些服务。镶嵌物，覆盖层和冠是主要恢复服务的典型例子。
aetna rx -Medicare -Keytruda（Pembrolizumab）注射药物预认证请求
是否有疾病复发或当前方案上不可接受的毒性的证据？是否对于非小细胞肺癌，头颈部鳞状细胞癌，经典的霍奇金淋巴瘤，原发性纵隔大B细胞淋巴瘤，尿素癌的一级癌（尿道的一伯癌）（上生殖型肿瘤，上种植肿瘤，包括尿素瘤的尿素癌） instability-high or mismatch repair deficient tumors, Gastric cancer, Esophagogastric junction cancer, Esophageal cancer, Cervical cancer, Hepatocellular carcinoma, Merkel cell carcinoma, Renal cell carcinoma (not adjuvant), Endometrial carcinoma, Tumor mutational burden-high cancer, Cutaneous squamous cell carcinoma, Triple-Negative Breast Cancer （TNBC）局部复发的不可切除或转移性，小肠腺癌，上皮卵巢癌，输卵管癌，原发性腹膜癌，癌肉瘤（恶性混合混合乳腺癌），卵巢较低的牛肉症，卵巢碳瘤的透明细胞癌，卵巢癌，卵巢癌，卵巢癌，一年级的卵巢癌。癌，神经内分泌肿瘤，乳腺癌，唾液腺肿瘤，骨癌，阴茎癌，子宫肉瘤：患者接受了多个月的治疗，接受了要求的药物？仅用于膀胱的尿路上皮癌：
Aetna Rx - 医疗保险表格 - Cimzia (certolizumab) 注射药物预先认证请求
不耐受或不良事件史 肾功能损害 超敏反应 酒精使用障碍、酒精性肝病或其他慢性肝病的临床诊断 肝转氨酶升高 显著的药物相互作用 骨髓发育不良 母乳喂养 间质性肺炎或临床显著的肺纤维化 怀孕或目前计划怀孕 血液异常（例如，血小板减少、白细胞减少、严重贫血） 其他，请解释：
01-01-2025（TX）AWH TENET ACO/OA AETNA选择Aetna
计划具有tenet ACO所有其他AETNA福利限制 - 某些服务或用品每年都有限制。每年可能有最大数量的访问或天数或美元限额。在这种情况下，收益年将于1月1日开始（除非另有说明）。请参阅您的计划文件以了解更多信息。可扣除额（每个日历年）每个人$ 3,000 $ 2,000每个个人$ 3,000每个家庭$ 4,000 $ 6,000 $ 6,000每个家庭承保的费用加起来，同时可扣除您的最大储蓄和标准储蓄。处方药成本不计入免赔额。有关详细信息，请参阅您的计划文件。您的家人将有一种自付额。，当几个家庭成员的费用加起来可扣除时，您将遇到它。没有人必须支付的费用超过个人扣除额。成员共同保险您支付的10％您支付30％的费用适用于所有费用，但如前所述。自付限额（每个日历年）
2024 FEHB计划绩效评估程序手册
Definitions of Terms We Use in This Brochure .....................................................................................................175 Index ..........................................................................................................................................................................................184 Summary of Benefits for the Aetna HealthFund CDHP Plan - 2025 ................................................................................................................................................................................................................. 189