By Counterforce Health Team in Voxzogo (vosoritide) —

How to Get Voxzogo (Vosoritide) Covered by Aetna CVS Health in Michigan: Complete 2025 Guide with Forms and Appeals

Quick Answer: Getting Voxzogo Covered by Aetna CVS Health in Michigan

Aetna CVS Health covers Voxzogo (vosoritide) for pediatric achondroplasia patients with open growth plates. Your fastest path to approval: (1) Confirm your child has documented achondroplasia via genetic testing or clinical/X-ray findings, (2) Verify open epiphyses through imaging, and (3) Have a pediatric endocrinologist, geneticist, or neurologist submit the prior authorization with growth velocity data. Start today by calling Aetna's specialty drug PA line at 1-800-294-5979 to request the current form. If denied, Michigan gives you 127 days to file an external appeal with DIFS, with decisions typically within 14 days.

Table of Contents

  1. Verify Your Plan and Find the Right Forms
  2. Prior Authorization Forms and Requirements
  3. Submission Portals and Electronic Options
  4. Fax and Mail Submission Details
  5. CVS Specialty Pharmacy Enrollment
  6. Support Phone Lines and Contacts
  7. Michigan Appeals and External Review
  8. Update Schedule for Resources

Verify Your Plan and Find the Right Forms

Before starting your Voxzogo prior authorization, confirm your specific Aetna plan type. Michigan residents typically have:

  • Commercial Aetna plans (employer-sponsored)
  • Aetna Medicare Advantage
  • Aetna Better Health of Michigan (Medicare-Medicaid)

Check your member ID card or call the number on the back to verify which specialty pharmacy network applies to your plan. Most Aetna members use CVS Caremark for specialty medications.

Tip: Aetna's specialty drug coverage criteria are updated annually. Always request the current year's form to avoid delays.

Prior Authorization Forms and Requirements

Coverage Requirements at a Glance

Requirement What It Means Where to Find It Source
Confirmed achondroplasia Genetic test OR clinical symptoms + X-ray Medical records, genetic testing report Aetna Policy
Open epiphyses Growth plates still open X-ray or bone age study Aetna Policy
Specialist prescriber Endocrinologist, geneticist, or neurologist Provider credentials Aetna Policy
Baseline growth data Height velocity before treatment Growth charts, clinic measurements Aetna Policy
Age requirement Pediatric patient ≥2 years Birth certificate, medical records FDA Label
Quantity limit 30 vials per 30 days Dosing calculation Aetna Quantity Limits

Key Documentation Needed

For Initial Authorization (12-month approval):

  • Completed Aetna prior authorization form
  • Genetic testing report showing FGFR3 mutation OR clinical documentation with X-ray findings
  • Radiographic evidence of open growth plates
  • Baseline growth velocity measurements
  • Specialist consultation notes
  • Weight-based dosing calculations

For Reauthorization:

  • All initial criteria still met
  • Objective evidence of growth velocity improvement or stabilization
  • Continued open epiphyses confirmation

Submission Portals and Electronic Options

Electronic Submission Options

Availity Provider Portal (recommended for providers):

  • Fastest processing for prior authorizations
  • Upload supporting documents directly
  • Track submission status
  • Availity.com (requires provider account)

CVS Caremark Provider Portal:

  • Alternative electronic submission
  • Access through CVS Caremark provider website
  • Requires registration and provider credentials
Note: Electronic submissions typically process faster than fax or mail. Ensure all required documents are attached as PDFs with clear, legible text.

Fax and Mail Submission Details

Commercial Plans

Prior Authorization Fax: 1-866-249-6155
Phone: 1-800-294-5979 (Monday-Friday, 8AM-6PM CST)

Medicare Advantage Plans

Fax: (verify with current Medicare PA request form)
Phone: 1-866-503-0857 (TTY: 711)

Mailing Address: CVS Caremark Prior Authorization
(confirm current address on PA form - addresses change periodically)

Cover Sheet Best Practices

  • Include member ID, date of birth, and drug name prominently
  • List all attached documents
  • Include provider contact information
  • Mark "URGENT" if expedited review needed
  • Keep a copy of everything sent

CVS Specialty Pharmacy Enrollment

Once Aetna approves your Voxzogo prescription, you'll need to enroll with CVS Specialty Pharmacy for dispensing and delivery.

Enrollment Steps

  1. Provider submits prescription to CVS Specialty at 1-800-237-2767
  2. Patient enrollment call - CVS will contact you within 24-48 hours
  3. Insurance verification - CVS confirms coverage and copay
  4. Delivery setup - Choose home or clinic delivery
  5. First shipment - Includes medication, syringes, and alcohol swabs

Transfer from Another Specialty Pharmacy

If you're switching from another specialty pharmacy:

  • Use the CVS prescription transfer portal
  • Call 1-800-237-2767 for complex transfers
  • Provide current prescription details and new delivery preferences
  • No additional cost for transfers

CVS Specialty Patient Portal: CVSCaremarkSpecialtyRx.com

  • Track deliveries
  • Request refills
  • Update delivery preferences
  • Access medication guides

Support Phone Lines and Contacts

For Providers

Plan Type Prior Authorization Case Management
Commercial 1-800-294-5979 Member Services
Medicare Advantage 1-866-503-0857 Case Manager
Better Health MI Member Services Assigned Case Manager

For Patients and Families

Aetna Member Services: Number on back of ID card
CVS Specialty Pharmacy: 1-800-237-2767 (24/7 support)
BioMarin RareConnections: 1-866-906-6100 (manufacturer support program)

What to Ask When Calling

  • "What specific documentation is missing from our PA request?"
  • "Can we schedule a peer-to-peer review with the medical director?"
  • "What's the timeline for a decision on this specialty drug?"
  • "Are there any formulary alternatives that might be covered?"

Michigan Appeals and External Review

If Aetna denies your Voxzogo request, Michigan provides strong consumer protection through the Department of Insurance and Financial Services (DIFS).

Step-by-Step Appeals Process

1. Internal Appeal with Aetna (First Level)

  • File within 180 days of denial
  • Submit additional clinical documentation
  • Request peer-to-peer review if available
  • Timeline: 30-45 days for standard, 72 hours for expedited

2. Michigan External Review (Final Level)

  • File with DIFS within 127 days of Aetna's final denial
  • Use DIFS online form or paper submission
  • Include copy of denial letter and supporting medical records
  • Timeline: 14 days standard, 72 hours expedited

Required Documents for DIFS Appeal

  • Aetna's final denial letter
  • Medical records supporting medical necessity
  • Provider letter explaining why Voxzogo is essential
  • For expedited appeals: physician certification of urgency

DIFS Contact Information:
Phone: 877-999-6442 (Monday-Friday, 8AM-5PM)
Website: michigan.gov/difs

From Our Advocates: We've seen families successfully overturn Aetna specialty drug denials by including comprehensive growth velocity data and clear documentation of FGFR3 mutations. The key is showing both medical necessity and meeting Aetna's specific criteria - don't just rely on general achondroplasia diagnosis.

Common Denial Reasons and Solutions

Denial Reason How to Fix Documentation Needed
"Experimental/investigational" Cite FDA approval for achondroplasia FDA label, Aetna policy
"Not medically necessary" Provide growth velocity data Baseline measurements, specialist notes
"Missing genetic confirmation" Submit genetic testing FGFR3 mutation report
"Epiphyses closed" Provide current imaging Recent X-ray or bone age study
"Wrong prescriber type" Transfer to specialist Referral to endocrinologist/geneticist

Update Schedule for Resources

Insurance policies and forms change regularly. Check these resources quarterly:

  • Aetna specialty drug policies: Updated annually (typically January)
  • Prior authorization forms: Check for version updates every 3 months
  • Michigan DIFS procedures: Review annually for regulatory changes
  • CVS Specialty processes: Monitor for portal updates and new submission options

Key dates to watch:

  • January: New formulary and PA criteria
  • July: Mid-year formulary updates possible
  • October: Medicare plan changes for following year

Frequently Asked Questions

How long does Aetna prior authorization take for Voxzogo in Michigan?
Standard PA decisions take 30-45 days. Expedited reviews (for urgent medical needs) are completed within 72 hours.

What if Voxzogo is non-formulary on my Aetna plan?
Request a formulary exception by demonstrating medical necessity and lack of suitable formulary alternatives. Include specialist documentation supporting Voxzogo specifically.

Can I appeal if my child ages out during the process?
Yes, but act quickly. File appeals before growth plates close, as this is a key coverage criterion that can't be appealed once epiphyses fuse.

Does step therapy apply to Voxzogo?
No specific step therapy requirements exist since Voxzogo is the only FDA-approved pharmacologic treatment for achondroplasia.

What financial assistance is available?
BioMarin RareConnections offers copay assistance and patient support services. Contact 1-866-906-6100 to check eligibility.

How do I get expedited review in Michigan?
Your doctor must certify that delay would harm your child's health. Submit this with your appeal to both Aetna and DIFS if needed.

About Counterforce Health: Counterforce Health helps families navigate complex insurance denials for specialty medications like Voxzogo. Our platform analyzes denial letters and creates targeted, evidence-based appeals that speak directly to payer policies and clinical requirements. By turning insurance obstacles into approval opportunities, we help ensure patients get the treatments they need without unnecessary delays.

When dealing with Aetna denials, Counterforce Health can help you understand exactly what documentation is missing and how to structure a winning appeal. Our approach combines payer-specific knowledge with clinical expertise to maximize your chances of coverage approval.

Sources and Further Reading

Disclaimer: This guide provides general information about insurance coverage and appeals processes. It is not medical advice and should not replace consultation with healthcare providers or insurance professionals. Coverage policies vary by plan and change over time. Always verify current requirements with your specific insurer and consult qualified professionals for medical and legal guidance. For official Michigan insurance assistance, contact DIFS at 877-999-6442.

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