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Aetna Precertification Notification Phone: 18667527021 FAX: 18882673277Orencia () Injectable Medication Precertification RequestFor Medicare Advantage Part B: Please Use Medicare Request FormPage 1 of 4 (All fields must be completed and legible for precertification review.)Please indicate:Start of treatment, start date: / / Continuation of therapy, date of last treatment://Precertification Requested By:Phone:Fax:A. PATIENT INFORMATIONFirst Name:Last Name:DOB:Address:City:State:Home

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