By Counterforce Health Team in Turalio (pexidartinib) —

How Long Does It Take to Get Turalio (pexidartinib) Approved by Aetna CVS Health in Ohio? Complete Timeline Guide

Quick Answer: Turalio (pexidartinib) Approval Timeline with Aetna CVS Health in Ohio

Aetna CVS Health typically completes prior authorization for Turalio (pexidartinib) within 14 days, with over 95% of eligible requests approved in less than 24 hours. For Ohio residents, the fastest path involves: (1) ensuring complete REMS enrollment and TGCT diagnosis documentation, (2) submitting via CVS Specialty at 1-855-633-7673, and (3) having your provider ready for potential peer-to-peer review. If denied, Ohio law provides two internal appeals plus external review through the Ohio Department of Insurance within 180 days.

Your first step today: Contact CVS Specialty at 1-800-237-2767 to confirm current PA requirements and obtain the Turalio-specific form.

Table of Contents

  1. What Affects Turalio Approval Timing
  2. Pre-Submission Preparation (0-2 Days)
  3. Submission to Initial Review (1-5 Days)
  4. Additional Information Requests (1-7 Days)
  5. Decision Window & Outcomes
  6. If Denied: Ohio Appeal Timeline
  7. Renewal Cycles & Ongoing Authorization
  8. Timeline Visual & Milestones
  9. Time-Saving Tips for Faster Approval

What Affects Turalio Approval Timing

Several factors influence how quickly Aetna CVS Health processes your Turalio (pexidartinib) prior authorization in Ohio:

Benefit Type & Plan Structure

  • CVS Specialty-managed plans: Typically faster (1-3 days) due to integrated systems
  • Traditional Aetna with CVS Caremark: Standard 7-14 day timeline
  • Self-funded employer plans: May have additional review layers

Clinical Complexity

  • Clear TGCT diagnosis with imaging: Fastest approval path
  • Surgical eligibility questions: May trigger medical director review
  • REMS compliance gaps: Automatic delay until enrollment verified

Documentation Completeness According to CVS Specialty requirements, incomplete submissions account for 60% of delays. Critical documents include:

  • Completed prior authorization form
  • TGCT diagnosis with ICD-10 codes
  • REMS program enrollment confirmation
  • Prior therapy history and failures
Tip: Aetna CVS Health uses automated systems for initial screening. Complete documentation can trigger same-day approval for straightforward cases.

Pre-Submission Preparation (0-2 Days)

Essential Checklist

Patient Information to Gather:

  • Insurance card with member ID
  • Aetna policy/group number
  • Patient demographics and contact information
  • Previous authorization numbers (if applicable)

Clinical Documentation:

  • TGCT diagnosis confirmation with imaging reports
  • ICD-10 codes (M12.2 series for TGCT)
  • Surgical consultation notes (why surgery isn't feasible)
  • Prior therapy attempts and outcomes
  • Current liver function tests (required for REMS)

REMS Program Requirements:

  • Prescriber REMS certification status
  • Patient enrollment in TURALIO REMS Program
  • Baseline hepatic function assessment
  • Monitoring plan documentation

Verification Steps

  1. Confirm formulary status via Aetna's drug lookup tool
  2. Check current PA form - CVS updates requirements annually
  3. Verify prescriber NPI and DEA registration
  4. Confirm patient eligibility through Aetna member services

Submission to Initial Review (1-5 Days)

How to Submit

Primary Method - CVS Specialty Fax:

  • Fax completed forms to 1-855-633-7673
  • Include all supporting documentation in single transmission
  • Expect fax confirmation within 2 hours

Alternative - Phone Submission:

  • Call CVS Specialty at 1-800-237-2767
  • Have all documentation ready for verbal review
  • Follow up with written confirmation

What Reviewers Check First

Aetna's initial review focuses on:

  1. Medical necessity criteria - TGCT diagnosis severity
  2. REMS compliance - Enrollment and monitoring plans
  3. Formulary status - Tier placement and restrictions
  4. Prior authorization completeness - All required fields
Note: Ohio state law requires insurers to acknowledge PA requests within 2 business days and provide estimated decision timelines.

Coverage at a Glance

Requirement What It Means Where to Find It Timeline Impact
Prior Authorization Required for all Turalio prescriptions CVS Specialty PA List +3-14 days
REMS Enrollment Mandatory safety program FDA TURALIO REMS website +1-3 days if incomplete
Step Therapy May require imatinib trial first Aetna policy bulletin +7-30 days if not documented
Quantity Limits 28-day supply maximum CVS formulary guidelines Minimal if within limits

Additional Information Requests (1-7 Days)

If Aetna requests additional information, response speed directly affects approval timing:

Common Requests:

  • Clarification of surgical contraindications
  • Additional liver function monitoring plans
  • Prior therapy documentation gaps
  • REMS enrollment verification

How to Respond Quickly:

  1. Respond within 24-48 hours to avoid review queue delays
  2. Use the same submission method (fax to same number)
  3. Reference original PA number on all correspondence
  4. Include complete documentation rather than partial responses
From our advocates: We've seen cases where providers submitted partial responses to information requests, extending the review by an additional 10-14 days. Always provide comprehensive documentation in your first response, even if it seems excessive.

Decision Window & Outcomes

Typical Decision Timeline

Standard Review: 7-14 calendar days from complete submission Expedited Review: 72 hours for urgent medical situations Complex Cases: Up to 30 days with medical director involvement

Reading Approval Letters

Full Approval:

  • Includes specific quantity and day supply limits
  • Lists any ongoing monitoring requirements
  • Provides authorization number for pharmacy use

Conditional Approval:

  • May require specific pharmacy (CVS Specialty)
  • Could include dosing restrictions
  • Might mandate regular lab monitoring

Partial Approval:

  • Reduced quantity or duration
  • May require step therapy completion
  • Often includes appeal rights information

If Denied: Ohio Appeal Timeline

Ohio residents have strong appeal rights when Aetna CVS Health denies Turalio coverage:

Internal Appeals (Required First Steps)

Level 1 Internal Appeal:

  • Deadline: 180 days from denial notice
  • Timeline: Standard 30 days, expedited 72 hours
  • Submission: Via member portal or written request

Level 2 Internal Appeal:

  • Deadline: 60 days from Level 1 denial
  • Timeline: 30 days for standard, 72 hours expedited
  • Review: Independent medical professionals

External Review (Ohio-Specific Rights)

After exhausting internal appeals, Ohio law provides external review through the Ohio Department of Insurance:

Eligibility: Medical necessity denials, experimental/investigational determinations Deadline: 180 days from final internal denial Process: Independent Review Organization (IRO) assignment Timeline: 30 days standard, 72 hours expedited Outcome: Binding decision on insurer

Ohio Department of Insurance Contact:

Appeal Success Factors

Research shows that Aetna specialty drug appeals have reversal rates exceeding 60-90% when properly documented. Key success factors include:

  1. Address specific denial reasons point-by-point
  2. Include updated clinical evidence and guidelines
  3. Provide peer-reviewed literature supporting TGCT treatment
  4. Document failed alternatives with specific outcomes
  5. Include provider letter of medical necessity

Renewal Cycles & Ongoing Authorization

When to Re-authorize

Turalio typically requires reauthorization every:

  • 6 months for initial approvals
  • 12 months for established stable patients
  • As needed for dosing changes or interruptions

Renewal Documentation

Required for Renewal:

  • Updated liver function tests
  • Treatment response assessment
  • Continued medical necessity justification
  • REMS compliance verification

Timeline for Renewals:

  • Submit 30 days before current authorization expires
  • Most renewals approved within 3-5 business days
  • No gap in coverage if submitted timely

Timeline Visual & Milestones

Standard Approval Process

Milestone Timeline Action Required Success Rate
Pre-submission prep Days 0-2 Gather documentation N/A
Initial submission Day 1 Fax to CVS Specialty N/A
Acknowledgment Days 1-2 None (automatic) 100%
Initial review Days 3-7 Respond to requests 85% approval
Medical director review Days 8-14 Peer-to-peer if needed 70% approval
Final decision Days 7-14 None 95% resolution

Expedited Timeline (Urgent Cases)

Milestone Timeline Requirements
Urgent request Day 1 Provider attestation
Priority review Hours 1-24 Complete documentation
Decision Hours 24-72 None

Time-Saving Tips for Faster Approval

Portal Usage

  • Use CVS Specialty online portal when available for real-time status updates
  • Set up provider alerts for decision notifications
  • Upload documents electronically to avoid fax delays

Bundled Evidence Strategy

Instead of submitting minimal documentation, include:

  • Complete medical history relevant to TGCT
  • All imaging studies and pathology reports
  • Comprehensive prior therapy documentation
  • REMS compliance certificates

Direct Specialty Routing

  • Submit directly to CVS Specialty rather than general Aetna PA
  • Use specialty-specific forms available on CVS Specialty website
  • Contact specialty pharmacy for status updates

Proactive Communication

  • Schedule peer-to-peer reviews immediately if requested
  • Prepare medical necessity letters before submission
  • Maintain regular contact with CVS Specialty coordinators

Frequently Asked Questions

How long does Aetna CVS Health prior authorization take for Turalio in Ohio? Most Turalio prior authorizations are completed within 7-14 days, with over 95% of eligible requests approved in less than 24 hours when documentation is complete.

What if Turalio is non-formulary on my Aetna plan? You can request a formulary exception by demonstrating medical necessity and failure of preferred alternatives. This process typically adds 7-14 days to the timeline.

Can I request expedited review for Turalio approval? Yes, if your provider attests that delays could seriously jeopardize your health. Expedited reviews are completed within 72 hours.

Does step therapy apply if I've tried similar medications outside Ohio? Previous therapy trials from any location count toward step therapy requirements, provided you have adequate documentation of failures or intolerances.

What happens if my REMS enrollment is incomplete? Turalio approval will be delayed until REMS enrollment is complete. This typically adds 1-3 days but can extend longer if monitoring plans need revision.

When to Get Help

For complex cases or persistent denials, consider working with coverage specialists who understand Aetna's specific requirements. Counterforce Health helps patients, clinicians, and specialty pharmacies get prescription drugs approved by turning insurance denials into targeted, evidence-backed appeals. Their platform ingests denial letters and plan policies to draft point-by-point rebuttals aligned to Aetna's own rules, significantly improving approval odds for medications like Turalio.

Ohio-Specific Resources:

  • Ohio Department of Insurance Consumer Services: 1-800-686-1526
  • UHCAN Ohio (consumer advocacy): Available for appeal assistance
  • Ohio Senior Health Insurance Information Program (OSHIIP): For Medicare-related issues

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 plan for specific coverage decisions. Coverage policies and requirements may change; verify current information with Aetna CVS Health and Ohio regulatory authorities before making coverage decisions.

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