Topic

Aetna (CVS Health)

A collection of 1071 issues

Getting Thiola / Thiola EC (tiopronin) Covered by Aetna in California: Complete PA Guide & Appeal Process

Answer Box: Getting Thiola / Thiola EC Covered by Aetna in California Aetna requires prior authorization for Thiola/Thiola EC (tiopronin) with 12-month initial approval based on confirmed cystinuria diagnosis, failed conservative therapy, and elevated 24-hour urine cystine levels (≥300 mg/day). Submit via prescriber through Availity portal with genetic testing,

Myths vs. Facts: Getting Somatuline Depot (Lanreotide) Covered by Aetna CVS Health in California

Answer Box: Getting Somatuline Depot Covered by Aetna CVS Health in California Aetna CVS Health requires prior authorization for Somatuline Depot (lanreotide) with specific criteria for acromegaly, GEP-NETs, and carcinoid syndrome. Key requirements include elevated IGF-1 levels, endocrinologist/oncologist prescription, and often prior octreotide trial. Fastest path: Submit complete PA

How to Get Brineura (Cerliponase Alfa) Covered by Aetna (CVS Health) in New York: Complete Appeals Guide

Answer Box: Getting Brineura Covered by Aetna (CVS Health) in New York Aetna requires prior authorization for Brineura (cerliponase alfa) under the medical benefit for pediatric CLN2 patients ≥3 years with confirmed TPP1 deficiency and motor function scores ≥1. Submit via neurologist with diagnosis confirmation, CLN2 Clinical Rating Scale scores,

How to Get Mycapssa (Octreotide Oral) Covered by Aetna CVS Health in Florida: Complete Prior Authorization Guide

Quick Answer: Getting Mycapssa Covered by Aetna CVS Health in Florida Aetna CVS Health requires prior authorization for Mycapssa (oral octreotide) with documented acromegaly diagnosis, prior response to injectable octreotide or lanreotide for 3+ months, and medical necessity justification for oral therapy. Submit through CVS Specialty (1-800-237-2767) with complete documentation.

Myths vs. Facts: Getting Jynarque (tolvaptan) Covered by Aetna (CVS Health) in Ohio

Answer Box: Getting Jynarque (tolvaptan) Covered by Aetna (CVS Health) in Ohio Fastest path to approval: Document rapid ADPKD progression (Mayo Classification 1C-1E or eGFR decline ≥3.0 mL/min/1.73 m²/year), complete REMS enrollment, and submit prior authorization through CVS Caremark with comprehensive clinical documentation. If denied,

How to Get Myalept (Metreleptin) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Myalept Covered by Aetna CVS Health in Virginia Myalept (metreleptin) requires prior authorization from Aetna CVS Health for generalized lipodystrophy (ICD-10 E88.12) only. The fastest path to approval: (1) Complete REMS certification at MyaleptREMS.com, (2) Submit PA with confirmed generalized lipodystrophy diagnosis, metabolic complications documentation,

How to Get Therakos CELLEX Photopheresis Covered by Aetna (CVS Health) in Florida: Prior Authorization Guide and Appeals Process

Answer Box: Getting Therakos CELLEX Covered by Aetna (CVS Health) in Florida Aetna (CVS Health) covers Therakos CELLEX photopheresis for cutaneous T-cell lymphoma (CTCL) and steroid-refractory graft-versus-host disease (GVHD) with prior authorization. Your specialist must document failed prior therapies and submit comprehensive clinical records via Aetna's provider portal.

Work With Your Doctor to Get Juxtapid (lomitapide) Approved by Aetna (CVS Health) in Washington

Answer Box: Getting Juxtapid (lomitapide) Covered by Aetna (CVS Health) in Washington Success requires strong provider partnership and complete documentation. Aetna typically requires genetic confirmation of homozygous familial hypercholesterolemia (HoFH), evidence of failed high-intensity statin plus ezetimibe therapy, baseline liver function tests, and REMS program enrollment. First step today: Schedule

How to Get Opsumit (Macitentan) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Opsumit Approved by Aetna CVS Health in North Carolina Opsumit (macitentan) requires prior authorization from Aetna CVS Health for pulmonary arterial hypertension (PAH) treatment. The fastest path: (1) Complete the Aetna Rx PA form with WHO Group 1 PAH diagnosis, step therapy documentation, and REMS enrollment, (2)

How to Get Busulfex (Busulfan Injection) Covered by Aetna CVS Health in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Busulfex Covered by Aetna CVS Health in Texas Busulfex (busulfan injection) requires prior authorization from Aetna CVS Health for bone marrow transplant conditioning in Texas. Submit your PA request through the Availity portal at least 14 days before treatment, including your CML diagnosis (ICD-10: C92.1), prior