By Counterforce Health Team in Natpara (parathyroid hormone) —

How Long Does It Take to Get Natpara (Parathyroid Hormone) Approved by Aetna CVS Health in Virginia? Timeline & Appeal Guide

Quick Answer: Natpara (parathyroid hormone) is currently unavailable for new prescriptions through Aetna CVS Health as Takeda discontinued manufacturing in 2024. Existing patients on the Special Use Program have access until December 31, 2025. For hypoparathyroidism treatment, work with your endocrinologist to request formulary exceptions for alternative therapies like high-dose calcium/calcitriol combinations. Submit prior authorization requests at least two weeks in advance through the Availity provider portal with complete medical documentation.

Table of Contents

  1. Current Natpara Availability Status
  2. What Affects Approval Timing
  3. Pre-Submission Preparation (0-2 Days)
  4. Submission to Initial Review (1-5 Days)
  5. Additional Information Requests (1-7 Days)
  6. Decision Window & Outcomes
  7. If Denied: Virginia Appeals Process
  8. Alternative Treatment Options
  9. Timeline Summary Table
  10. Frequently Asked Questions

Current Natpara Availability Status

Important Update: Takeda Pharmaceuticals discontinued Natpara manufacturing globally at the end of 2024. The U.S. Special Use Program will cease all shipments by December 31, 2025. This means:

  • New prescriptions: Generally not approved by any payer, including Aetna CVS Health
  • Existing patients: May continue receiving Natpara through the Special Use Program until the end of 2025
  • Alternative treatments: Focus should shift to optimized calcium and active vitamin D regimens

If you're currently on Natpara, work with your endocrinologist now to develop a transition plan before the program ends.

What Affects Approval Timing

Several factors influence how quickly Aetna CVS Health processes specialty endocrine medication requests in Virginia:

Benefit Type Complexity:

  • Medicare Advantage: Standard decisions within 72 hours of receiving supporting documentation
  • Commercial plans: Up to two weeks once complete information is submitted
  • Medicaid managed care: Follows Virginia Medicaid timelines (typically 14 days)

Documentation Completeness: Aetna reports that more than 95% of eligible prior authorizations are approved within 24 hours, but incomplete submissions cause significant delays.

Clinical Complexity: Rare endocrine conditions like hypoparathyroidism often require additional clinical review, extending standard timelines.

Pre-Submission Preparation (0-2 Days)

Checklist: What to Gather Before You Start

Patient Information:

  • Aetna member ID card and policy details
  • Complete diagnosis with ICD-10 codes (E20.9 for hypoparathyroidism)
  • Current medications and dosages
  • Recent lab results (serum calcium, phosphorus, PTH levels)

Clinical Documentation:

  • Endocrinologist's treatment notes
  • Documentation of conventional therapy trials and outcomes
  • Kidney function tests (creatinine, eGFR)
  • Any prior authorization denial letters

Provider Requirements:

Tip: Contact CVS Specialty Pharmacy at 1-866-814-5506 to verify current form requirements before submission.

Submission to Initial Review (1-5 Days)

How to Submit Your Request

Primary Submission Methods:

  1. Availity Provider Portal (fastest option) - Submit electronically
  2. CVS Caremark Fax: 1-866-249-6155
  3. Phone: 1-866-814-5506 for specialty medications

What Reviewers Check First:

  • Complete patient and provider information
  • Accurate diagnosis codes and clinical indication
  • Previous therapy documentation
  • Formulary status and coverage tier

Virginia-Specific Requirements: Virginia insurance regulations require Aetna to acknowledge receipt within 2 business days and begin clinical review promptly.

Additional Information Requests (1-7 Days)

If Aetna requests additional information, respond quickly to avoid delays:

Common Information Requests:

  • Additional lab values or imaging results
  • Detailed prior therapy failure documentation
  • Specialist consultation notes
  • Updated treatment plans or monitoring protocols

How to Respond Quickly:

  • Use the same submission method as your original request
  • Reference your original case number
  • Submit complete documentation in a single transmission
Note: Failure to respond to information requests within the specified timeframe (typically 14 days) may result in automatic denial.

Decision Window & Outcomes

Typical Decision Timelines

Standard Reviews:

  • Commercial plans: 14 calendar days maximum
  • Medicare Advantage: 72 hours after complete submission
  • Expedited reviews: 24 hours for urgent medical situations

Reading Your Decision Letter:

  • Approved: Look for authorization number, approved quantity, and duration
  • Denied: Review specific denial reasons and appeal rights information
  • Pending: Additional information needed - respond promptly

Given Natpara's discontinued status, most new requests will likely be denied with recommendations for alternative therapies.

If Denied: Virginia Appeals Process

Internal Appeals with Aetna CVS Health

Timeline for Appeals:

  • Standard appeals: 30 days for pre-service denials
  • Expedited appeals: 72 hours if delay could jeopardize health
  • Claims appeals: 60 days for post-service denials

How to File:

  • Submit through Aetna provider portal or member portal
  • Include additional clinical documentation supporting medical necessity
  • Request peer-to-peer review with an endocrinologist if available

Virginia External Review Process

After exhausting Aetna's internal appeals, Virginia residents can request external review through the State Corporation Commission Bureau of Insurance:

External Review Timeline:

  • Standard review: 45 days maximum
  • Expedited review: 72 hours for urgent situations
  • Filing deadline: 120 days from final internal denial

How to File External Review:

  1. Complete Form 216-A External Review Request
  2. Submit to Virginia Bureau of Insurance
  3. Include all medical records and denial correspondence
  4. No fee required for Virginia residents
Virginia Resource: Contact the Bureau of Insurance Consumer Services at 1-877-310-6560 for guidance on external review eligibility.

Alternative Treatment Options

Since Natpara is no longer available for new patients, focus on these evidence-based alternatives:

Optimized Conventional Therapy:

  • High-dose calcium carbonate or calcium citrate
  • Active vitamin D analogs (calcitriol, paricalcitol)
  • Thiazide diuretics to reduce calcium excretion
  • Magnesium supplementation if deficient

Potential Off-Label Options:

  • Teriparatide (Forteo) - requires careful monitoring and specific clinical justification
  • Cinacalcet for certain cases with hypercalciuria

Coverage Strategy: Work with your endocrinologist to document why standard therapy is insufficient and request formulary exceptions for higher-tier alternatives through the same prior authorization process.

Timeline Summary Table

Phase Duration Key Actions Virginia-Specific Notes
Preparation 0-2 days Gather documentation, complete forms Ensure Virginia provider NPI included
Submission 1 day Submit via Availity or fax Virginia requires 2-day acknowledgment
Initial Review 1-14 days Clinical review by Aetna 72 hours for Medicare, 14 days commercial
Additional Info 1-7 days Respond to requests promptly 14-day response window typical
Decision Same day Receive approval/denial notice Electronic notification preferred
Internal Appeal 30-72 hours File appeal if denied Expedited available for urgent cases
External Review 45 days Virginia Bureau of Insurance Free process, 120-day filing deadline

Frequently Asked Questions

How long does Aetna CVS Health prior authorization take in Virginia? For specialty medications, standard requests take up to 14 days for commercial plans and 72 hours for Medicare Advantage once complete documentation is received.

What if Natpara is non-formulary on my Aetna plan? You can request a formulary exception with medical necessity documentation. However, given Natpara's discontinued status, focus on exceptions for alternative therapies like optimized calcium/vitamin D regimens.

Can I request an expedited appeal in Virginia? Yes, if your doctor certifies that standard timing could seriously jeopardize your health. Expedited appeals are decided within 72 hours for urgent medical situations.

Does step therapy apply to endocrine medications? Aetna may require trial of preferred alternatives before approving higher-tier medications. Document failures or contraindications to preferred agents in your prior authorization request.

What happens after December 31, 2025? All Natpara access through the Special Use Program ends. Work with your endocrinologist now to transition to alternative therapies and establish coverage for your new treatment regimen.

How do I contact Virginia insurance regulators? Contact the Virginia Bureau of Insurance Consumer Services at 1-877-310-6560 for help with coverage disputes or external review questions.

About Counterforce Health

Counterforce Health specializes in turning insurance denials into successful appeals for patients needing specialty medications. Our platform analyzes denial letters and payer policies to create targeted, evidence-backed appeals that align with each plan's specific requirements. For complex cases like endocrine disorders requiring specialty therapies, we help clinicians craft compelling medical necessity arguments using the right clinical evidence and procedural requirements.

When facing coverage challenges for rare disease treatments, having expert support can make the difference between denial and approval. Counterforce Health works with patients, clinicians, and specialty pharmacies to navigate the complex prior authorization and appeals process, ensuring that medically necessary treatments reach the patients who need them.

Medical Disclaimer: This information is for educational purposes only and does not constitute medical advice. Always consult with your healthcare provider and insurance plan for specific coverage decisions and treatment recommendations. Coverage policies and procedures may change; verify current requirements with Aetna CVS Health and Virginia regulatory authorities.

Sources & Further Reading

Powered by Counterforce Health—AI that turns drug denials into evidence-based appeals patients and clinicians can submit today.