By Counterforce Health Team in Increlex (mecasermin) —

Renewing Increlex (mecasermin) Approval with Aetna CVS Health in New Jersey: Complete Timeline & Documentation Guide

Answer Box: Renewing Increlex (mecasermin) with Aetna CVS Health in New Jersey

Increlex (mecasermin) approvals with Aetna typically last 12 months and require annual reauthorization. Start renewal 30-45 days before expiration with updated growth data showing at least 2 cm/year velocity, open epiphyses confirmation, and safety monitoring records. Submit through your pediatric endocrinologist's office via CVS Caremark specialty pharmacy. If denied, New Jersey's Independent Health Care Appeals Program (IHCAP) provides external review within 180 days.

First step today: Check your current PA end date from Aetna's approval letter and schedule an endocrinology visit 2-3 months before expiration.

Table of Contents

  1. Renewal Triggers: When to Start Planning
  2. Evidence Update: What Aetna Needs to See
  3. Renewal Documentation Package
  4. Timeline for Submission
  5. If Your Coverage Lapses
  6. Annual Plan Changes to Monitor
  7. Personal Renewal Tracker
  8. Appeals Process for New Jersey
  9. FAQ

Renewal Triggers: When to Start Planning

Your Increlex (mecasermin) prior authorization with Aetna CVS Health doesn't automatically renew. Here's when to begin your renewal process:

Standard 12-Month Approval Cycle

Most Aetna plans approve Increlex for 12 months, requiring annual reauthorization with documented clinical response and safety monitoring. Some situations may result in 6-month approvals, particularly for:

  • New patients starting therapy
  • Cases with incomplete baseline documentation
  • Patients with concerning safety signals

Early Planning Triggers

Start your renewal process when you notice these signs:

  • 90 days before expiration: Schedule your child's next endocrinology appointment
  • 60 days before: Request updated bone age X-ray if it's been over 12 months
  • 45 days before: Begin gathering growth velocity calculations and lab results
  • 30 days before: Submit complete renewal package
Tip: Set a calendar reminder for 90 days before your PA expires. Most families forget until they're contacted about an upcoming shipment delay.

Evidence Update: What Aetna Needs to See

Aetna's renewal criteria focus on demonstrating continued medical necessity and treatment response. Here's what your endocrinologist needs to document:

Growth Response Documentation

Growth velocity requirement: At least 2 cm per year during the most recent year of treatment. Your clinic should provide:

  • Height measurements from the past 12-18 months with specific dates
  • Calculated annual growth velocity in cm/year
  • Growth charts showing trajectory compared to normal ranges
  • Clear statement that growth response justifies continued therapy

Safety Monitoring Records

Aetna expects ongoing safety documentation including:

  • Hypoglycemia monitoring: Records of blood glucose checks and any episodes
  • IGF-1 levels: Recent lab showing levels within normal range for age/sex
  • Injection site assessment: Notes about rotation and absence of lipohypertrophy
  • Adverse events: Documentation of any side effects and management

Bone Age Confirmation

Open epiphyses requirement: Recent imaging (within 12-18 months) confirming growth plates remain open. Without this, Aetna will deny renewal since further linear growth isn't possible.

Renewal Documentation Package

Your pediatric endocrinologist's office should submit a complete package including:

Required Clinical Documents

Document What to Include Source
Medical necessity letter Growth velocity data, safety monitoring, continued indication Pediatric endocrinologist
Growth charts 12-18 months of height/weight data with velocity calculations Clinic records
Bone age report Confirmation of open epiphyses within past 12-18 months Radiology
Lab results Recent IGF-1 levels, safety labs as clinically indicated Laboratory
Medication adherence Refill history, dosing compliance notes CVS Specialty Pharmacy

Letter of Medical Necessity Checklist

Your endocrinologist's renewal letter should address:

  • Original diagnosis confirmation: Severe primary IGF-1 deficiency with baseline labs
  • Treatment response: Specific growth velocity achieved (cm/year)
  • Safety profile: Hypoglycemia management, IGF-1 monitoring
  • Continued need: Open epiphyses, haven't reached adult height
  • Alternative therapies: Why other treatments remain inappropriate
Clinician Corner: Include the phrase "severe primary IGF-1 deficiency" explicitly in your letter. Aetna's reviewers look for this exact terminology to match FDA labeling criteria.

Timeline for Submission

Optimal Submission Window

Submit 30-45 days before expiration to avoid coverage gaps. Here's the typical timeline:

  1. Day 0: Submit complete renewal package via CVS Caremark specialty pharmacy
  2. Days 1-3: Aetna acknowledges receipt and begins review
  3. Days 7-14: Standard review period (expedited available if urgent)
  4. Day 15: Decision notification to prescriber and patient
  5. Days 16-30: Appeal window if denied

Expedited Review Options

Request expedited review (24-hour decision) if:

  • Current approval expires within 72 hours
  • Delay would cause significant clinical deterioration
  • Patient has documented growth failure without treatment

Contact CVS Caremark at 1-866-814-5506 to request expedited processing.

If Your Coverage Lapses

Immediate Steps for Coverage Gaps

If your Increlex approval expires before renewal:

  1. Contact CVS Specialty immediately: Request emergency supply while appeal is pending
  2. File expedited appeal: Document urgent medical necessity
  3. Explore patient assistance: Ipsen's patient support programs may provide temporary supply
  4. Consider external review: New Jersey's IHCAP can override Aetna's decision

Bridge Therapy Options

While specific bridge programs weren't detailed in current policies, options include:

  • Manufacturer assistance: Contact Ipsen's patient support at 1-855-463-5127
  • Emergency fills: CVS Specialty may provide short-term supply during appeals
  • Provider samples: Some endocrinology clinics maintain limited sample inventory

Annual Plan Changes to Monitor

Formulary Updates to Watch

Aetna publishes formulary changes for New Jersey plans on fixed dates (January 1, April 1, July 1, October 1). Monitor for:

  • Tier placement changes: Increlex moving to higher cost-sharing tiers
  • New prior authorization requirements: Additional utilization management
  • Quantity limit modifications: Changes to monthly supply limits
  • Step therapy additions: Requirements to try alternatives first

How to Verify Current Status

Use Aetna's medication search tool to confirm Increlex status for your specific plan:

  1. Visit Aetna's formulary lookup (verify current link with member services)
  2. Select your exact plan type (commercial, exchange, Medicaid)
  3. Search "Increlex" or "mecasermin"
  4. Review tier, PA requirements, and any restrictions

Personal Renewal Tracker

Essential Dates to Log

Item Date Status Notes
Current PA expiration _________ From Aetna approval letter
Next endocrinology visit _________ Schedule 60-90 days before PA expires
Bone age due _________ If >12 months since last X-ray
Renewal submission target _________ 30-45 days before expiration
CVS Specialty next shipment _________ Coordinate with PA timeline

Growth Monitoring Log

Track these measurements at each visit:

  • Height: _____ cm (date: _____)
  • Weight: _____ kg (date: _____)
  • Growth velocity: _____ cm/year
  • IGF-1 level: _____ ng/mL (date: _____)

Appeals Process for New Jersey

Internal Appeals with Aetna

If your renewal is denied:

Level 1 (Standard): 30 days to file, 30-day decision timeline Level 2 (Final internal): 30 days to file, 30-day decision timeline

Submit appeals through CVS Caremark or Aetna's member portal with:

  • Complete denial letter
  • Additional clinical documentation
  • Updated medical necessity letter addressing denial reasons

External Review Through IHCAP

New Jersey's Independent Health Care Appeals Program provides binding external review:

Eligibility: After completing Aetna's internal appeals (both levels) Timeline: 180 days from final internal denial to file Process: Submit directly to Maximus Federal Services (contracted review organization) Cost: Free to patients; insurers pay all costs Decision: Binding on Aetna if overturned

Contact IHCAP: 1-888-393-1062 or through New Jersey Department of Banking and Insurance (verify current contact with DOBI at 1-800-446-7467).

When External Review Helps

IHCAP reviewers frequently overturn denials for specialty medications when:

  • Clear medical necessity exists
  • Treatment follows FDA labeling
  • Growth response is documented
  • Safety monitoring is appropriate
From our advocates: We've seen families succeed with IHCAP appeals by including a detailed timeline showing their child's growth improvement on Increlex compared to pre-treatment velocity. The independent medical reviewers appreciate seeing concrete evidence of treatment benefit over time.

FAQ

How long does Aetna CVS Health PA renewal take in New Jersey? Standard review takes 30-45 days. Expedited review (for urgent cases) takes 24-72 hours. Submit 30-45 days before expiration to avoid gaps.

What if Increlex becomes non-formulary on my plan? Request a formulary exception with medical necessity documentation. Aetna must provide transition supplies during the exception review process.

Can I request expedited renewal if my child is growing well? Expedited review is typically reserved for urgent medical situations. Consistent growth response supports standard renewal timing.

Does New Jersey require step therapy for Increlex renewals? Step therapy requirements vary by plan. Check your specific formulary, as some plans may require trying growth hormone therapy first for certain diagnoses.

What happens if I miss the renewal deadline? File an expedited appeal immediately and contact CVS Specialty for emergency supply options. New Jersey's external review remains available for 180 days.

Can my endocrinologist appeal on my behalf? Yes, providers can file appeals with patient consent. Many endocrinology offices handle PA appeals routinely for their patients.

Counterforce Health helps patients, clinicians, and specialty pharmacies turn insurance denials into successful appeals through evidence-backed, payer-specific strategies. Our platform analyzes denial letters and crafts targeted rebuttals aligned with plan policies, pulling the right clinical evidence and meeting procedural requirements for coverage determinations and external reviews.

This article provides educational information only and does not constitute medical or legal advice. Always consult with your healthcare provider and insurance plan for specific guidance. For questions about New Jersey insurance appeals, contact the Department of Banking and Insurance Consumer Hotline at 1-800-446-7467.

Sources & Further Reading

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