By Counterforce Health Team in Vanflyta (quizartinib) —

Get Vanflyta (Quizartinib) Approved by Aetna CVS Health in Texas: Complete Forms & Appeals Guide

Answer Box: Get Vanflyta Covered by Aetna CVS Health in Texas

Vanflyta (quizartinib) requires prior authorization from Aetna CVS Health for FLT3-ITD positive acute myeloid leukemia. Start by confirming your FLT3-ITD test results, then submit the current Aetna PA form with EKG documentation showing QTc ≤ 450ms. If denied, you have 180 days to appeal internally, followed by external review through a Texas-certified IRO. First step today: Download the 2024 Aetna Vanflyta PA form (verify with your plan) and gather your FLT3-ITD lab report and baseline EKG.

Table of Contents

  1. Verify Your Plan & Find the Right Forms
  2. Prior Authorization Forms & Requirements
  3. Submission Portals & Electronic Process
  4. Fax, Mail & Cover Sheet Tips
  5. CVS Specialty Pharmacy Setup
  6. Support Lines & Who to Call
  7. Texas Appeals Process & External Review
  8. Common Denial Reasons & How to Fix Them
  9. When to Update Your Resources

Verify Your Plan & Find the Right Forms

Before starting any prior authorization request, confirm you're working with the correct Aetna plan and formulary. Aetna CVS Health operates multiple plan types with different requirements:

  • Commercial plans (employer-sponsored)
  • Medicare Advantage plans
  • Medicaid managed care (Aetna Better Health)
Tip: Call the member services number on your insurance card to confirm your specific plan's formulary status for Vanflyta and current PA requirements.

Coverage at a Glance:

Requirement What It Means Where to Find It
Prior Authorization Required for all Aetna plans Aetna 2024 Precertification List
FLT3-ITD Testing Must document positive mutation Lab report from approved assay
EKG Monitoring QTc ≤ 450ms at baseline EKG report with interpretation
Specialty Pharmacy CVS Specialty required CVS Caremark network
Appeals Deadline 180 days from denial Texas state law

Prior Authorization Forms & Requirements

Vanflyta requires comprehensive clinical documentation due to its cardiac risks and specific genetic indication. Here's what you'll need:

Essential Documents Checklist

  • FLT3-ITD mutation test results (PCR-based assay preferred)
  • Baseline EKG showing QTcF ≤ 450ms
  • AML diagnosis confirmation with ICD-10 codes
  • Treatment plan (induction, consolidation, or maintenance phase)
  • Electrolyte correction documentation (if applicable)

Current PA Form Requirements

The Aetna Vanflyta Prior Authorization Form requires:

  1. Patient demographics and Aetna member ID
  2. Prescriber NPI and contact information
  3. Diagnosis details with specific AML subtype
  4. FLT3-ITD mutation status and allelic ratio (if available)
  5. Intended treatment phase and duration
  6. Cardiac safety data including baseline QTc interval
Note: Forms are updated regularly. Always verify you're using the current version by checking the Aetna provider portal or calling CVS Caremark.

Submission Portals & Electronic Process

Electronic Prior Authorization (ePA) is the fastest method for Vanflyta requests, typically providing decisions within 24-48 hours compared to 2-3 days for fax submissions.

CVS Caremark Provider Portal

  1. Register at the CVS Caremark Pharmacy Portal
  2. Log in and select "Prior Authorization"
  3. Enter patient details using their CVS Caremark member ID
  4. Complete the digital form with drug-specific questions
  5. Upload supporting documents (lab reports, EKG, clinical notes)
  6. Submit and track your request status

EHR Integration Options

Many electronic health record systems integrate directly with CVS Caremark through:

  • CoverMyMeds
  • Surescripts
  • Direct EHR connectivity

Check with your EHR vendor for available integrations to streamline the process.

Fax, Mail & Cover Sheet Tips

If electronic submission isn't available, use these backup methods:

Fax Submission

  • CVS Caremark PA Fax: (verify current number with your plan)
  • Include cover sheet with patient name, member ID, and drug name
  • Fax confirmation should be retained for appeals

Mail Submission

Aetna Provider Resolution Team
PO Box 14020
Lexington, KY 40512

Important: Always use certified mail for appeals and keep tracking numbers.

CVS Specialty Pharmacy Setup

Vanflyta must be dispensed through CVS Specialty Pharmacy for most Aetna plans. Here's the setup process:

Patient Enrollment Steps

  1. Obtain PA approval before contacting specialty pharmacy
  2. Call CVS Specialty at 1-800-237-2767
  3. Provide required information:
    • Insurance card and member ID
    • Prescriber contact information
    • Shipping address and preferences
  4. Schedule delivery and confirm refrigeration requirements
  5. Set up refill reminders and adherence support

Transfer from Retail Pharmacy

If your prescription was initially sent to a retail pharmacy:

  • Contact CVS Specialty to initiate transfer
  • Provide original prescription details
  • Confirm PA approval is attached to the transferred prescription

Support Lines & Who to Call

When you need help navigating the approval process, these contacts can provide assistance:

Aetna Member Services

  • Phone: Number on your insurance card
  • Hours: 24/7 for urgent issues
  • What to ask: PA status, formulary tier, appeals deadlines

CVS Caremark Provider Support

  • Phone: 1-800-294-5979
  • Hours: Monday-Friday, 8 AM - 8 PM ET
  • What to ask: ePA technical issues, form requirements, submission status

Prescriber Peer-to-Peer Review

If your initial PA is denied, request a peer-to-peer review:

  • Available through: CVS Caremark provider portal
  • Timeline: Usually scheduled within 24-48 hours
  • Preparation: Have clinical rationale and guidelines ready

Counterforce Health specializes in turning insurance denials into successful appeals by analyzing denial letters, plan policies, and clinical notes to create targeted, evidence-backed rebuttals. Their platform helps identify the specific denial basis and drafts point-by-point responses aligned to each plan's requirements, potentially saving weeks in the appeals process.

Texas Appeals Process & External Review

Texas provides strong patient rights for appealing insurance denials, including access to independent external review.

Internal Appeal Process

Timeline: File within 180 days of denial
Decision: Aetna must respond within 45-60 business days

Required Documents:

Submission Options:

  • Availity provider portal (for providers)
  • Mail: Aetna Provider Resolution Team, PO Box 14020, Lexington, KY 40512
  • Expedited appeals available for urgent cases

External Review (Texas IRO)

If Aetna denies your internal appeal, Texas law guarantees access to independent external review:

Texas Department of Insurance IRO Contacts:

  • IRO Information Line: 1-866-554-4926
  • Main TDI Line: 1-800-578-4677
  • Online: Texas Department of Insurance website

External Review Timeline:

  • Request deadline: Within 4 months of final denial
  • Standard review: Decision within 20 days
  • Expedited review: Decision within 72 hours (if health at risk)

No cost to patients for IRO review on fully insured plans.

Common Denial Reasons & How to Fix Them

Denial Reason How to Overturn Required Documentation
"No FLT3-ITD documentation" Submit clear lab report PCR-based assay showing positive ITD mutation
"Cardiac risk concerns" Provide EKG and monitoring plan Baseline EKG with QTc ≤ 450ms, cardiology clearance if needed
"Step therapy required" Document prior FLT3 inhibitor use/failure Treatment history, intolerance documentation
"Not medically necessary" Clinical guidelines and peer review NCCN guidelines, FDA labeling, prescriber letter
"Experimental/investigational" FDA approval documentation FDA label, indication-specific use

Clinician Corner: Medical Necessity Letter Checklist

When writing a medical necessity letter for Vanflyta, include:

  • Patient diagnosis: Acute myeloid leukemia with FLT3-ITD mutation
  • Prior treatments: Previous therapies tried and outcomes
  • Clinical rationale: Why Vanflyta is appropriate for this patient's specific situation
  • Guideline support: Reference to NCCN Guidelines or FDA labeling
  • Monitoring plan: EKG schedule and safety monitoring protocols
  • Treatment goals: Expected outcomes and duration
From our advocates: In our experience with FLT3 inhibitor appeals, the most successful cases include both genetic testing results and a clear cardiac safety plan. One composite case involved a patient whose initial denial was overturned after the oncologist provided detailed documentation of the FLT3-ITD allelic ratio and a cardiologist's clearance letter. This comprehensive approach addressed the payer's specific safety concerns.

When to Update Your Resources

Insurance policies and forms change regularly. Stay current by:

Monthly Checks

  • Aetna formulary updates (typically monthly)
  • PA form versions on Aetna provider portal
  • CVS Caremark policy changes

Quarterly Reviews

  • Appeals contact information
  • State regulatory updates from Texas Department of Insurance
  • External review procedures

Annual Updates

  • Plan benefit changes (usually January)
  • Formulary tier modifications
  • Prior authorization criteria revisions

For the most current information, bookmark:

FAQ

How long does Aetna CVS Health PA take in Texas?
Electronic submissions typically receive decisions within 24-48 hours. Standard mail/fax requests may take 3-5 business days. Expedited reviews for urgent cases are processed within 24 hours.

What if Vanflyta is non-formulary on my plan?
Request a formulary exception by documenting medical necessity and providing clinical evidence. Include information about why formulary alternatives aren't appropriate for your specific case.

Can I request an expedited appeal in Texas?
Yes, expedited appeals are available when delays could jeopardize your health. Both internal appeals and external reviews can be expedited, with decisions required within 72 hours.

Does step therapy apply if I've tried other FLT3 inhibitors outside Texas?
Treatment history from any state should count toward step therapy requirements. Provide complete documentation of previous therapies, including dates, doses, and reasons for discontinuation.

What happens if my external review is approved?
IRO decisions are binding in Texas. If the external review overturns Aetna's denial, they must comply and provide coverage for Vanflyta according to the reviewer's determination.

Sources & Further Reading

Disclaimer: This information is for educational purposes only and does not constitute medical or legal advice. Always consult with your healthcare provider and insurance company for specific coverage decisions. For additional help with insurance appeals in Texas, contact the Texas Department of Insurance at 1-800-578-4677 or visit their website for consumer assistance resources.

Counterforce Health helps patients, clinicians, and specialty pharmacies navigate complex prior authorization requirements by analyzing denial letters and creating targeted appeals. Visit www.counterforcehealth.org to learn more about their evidence-based approach to overturning insurance denials.

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