Anecortave Acetate (Retaane) — CPB 0706 | AETNA Coverage Update

TL;DR: Aetna modified CPB 0706 for anecortave acetate (Retaane), effective November 26, 2025. The drug remains non-covered for all indications — here's what billing teams need to know before submitting claims.

Aetna, a CVS Health company, updated CPB 0706 — its coverage policy governing anecortave acetate (Retaane) — with an effective date of November 26, 2025. The policy classifies anecortave acetate as experimental, investigational, or unproven for age-related macular degeneration, glaucoma, and retinoblastoma. If your practice treats any of these conditions and has explored Retaane as a treatment option, expect a claim denial. There are no covered indications under this policy.

Quick-Reference Table

Aetna Anecortave Acetate Coverage Criteria and Medical Necessity Requirements 2025

The short answer on medical necessity for anecortave acetate under Aetna's coverage policy: there is none. Aetna does not recognize any clinical scenario where anecortave acetate meets medical necessity standards. The drug has no covered indications under CPB 0706.

This is not a situation where prior authorization could unlock coverage. Prior authorization only applies when a payer considers a service covered but wants to review it first. When a payer classifies a drug as experimental or investigational — as Aetna does here — prior authorization is not a path to reimbursement. Submitting a prior auth request for Retaane will not change the outcome.

The three indications Aetna explicitly calls out — age-related macular degeneration, glaucoma, and retinoblastoma — are the conditions most likely to appear on a claim. If your practice is treating any of these with anecortave acetate, you need to have a payer coverage conversation with the patient before the visit, not after the claim comes back denied.

The Aetna anecortave acetate coverage policy has related policies worth reviewing. CPB 0701 covers Vascular Endothelial Growth Factor (VEGF) inhibitors for ocular indications — and VEGF inhibitors are the standard of care for wet AMD where Retaane has historically been investigated as an alternative. If your retina practice is billing for anti-VEGF therapy alongside or instead of anecortave acetate, make sure your claims map to CPB 0701, not CPB 0706.

Aetna Anecortave Acetate Exclusions and Non-Covered Indications

Aetna classifies anecortave acetate as experimental, investigational, or unproven across every indication it has been studied for. The policy does not leave room for interpretation here.

The three named indications are:

The policy notes this is "not an all-inclusive list." That language matters. Aetna is signaling that any other indication for anecortave acetate would also be considered non-covered — not just the three named ones. If you're looking at an off-label use case not listed here, don't assume it's covered by omission.

The real issue with a blanket experimental designation is that it closes off every standard billing pathway. There's no appeal based on medical necessity because Aetna's position is that effectiveness has not been established — full stop. Your billing team should treat any anecortave acetate claim as a guaranteed denial under this policy.

Coverage Indications at a Glance

Aetna Anecortave Acetate Billing Guidelines and Action Items 2025

Anecortave acetate billing under Aetna ends here. These are the steps your billing team and practice manager need to take before and after November 26, 2025.

CPT, HCPCS, and ICD-10 Codes for Anecortave Acetate Under CPB 0706

The policy data for CPB 0706 does not list specific CPT or HCPCS procedure codes. Anecortave acetate (Retaane) is classified as experimental across all indications, so no procedure code for its administration carries a covered status under this policy.

If your team has been billing Retaane under a miscellaneous drug HCPCS code, that claim will be denied. The absence of a specific HCPCS code in this policy does not create a coverage loophole — it reflects the fact that Aetna does not intend to cover this drug under any code.

Key ICD-10-CM Diagnosis Codes Under CPB 0706

These are the diagnosis codes associated with conditions Aetna explicitly identifies as non-covered indications for anecortave acetate. Any claim pairing these codes with anecortave acetate will be denied.

A Note on Related Aetna Policies

CPB 0706 references four related policies. These are the covered alternatives your billing team should know:

If your practice bills for any of these services, those policies have their own coverage criteria, prior authorization requirements, and billing guidelines. Do not assume CPB 0706's experimental designation carries over to these related treatments — it does not.