Topic

Aetna (CVS Health)

A collection of 640 issues

How to Get Waylivra (Volanesorsen) Covered by Aetna CVS Health in New Jersey: Appeals Guide and Policy Details

Answer Box: Getting Waylivra Covered by Aetna CVS Health in New Jersey Waylivra (volanesorsen) is not on Aetna's standard formulary and requires a medical exception appeal, not routine prior authorization. For familial chylomicronemia syndrome (FCS), you'll need genetic confirmation, triglycerides >875 mg/dL on multiple

How to Get Amondys 45 (Casimersen) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Amondys 45 Covered by Aetna CVS Health in North Carolina Aetna CVS Health requires prior authorization for Amondys 45 (casimersen) with strict documentation: genetic testing confirming exon 45-amenable DMD mutation, age under 14, specialist prescription, and detailed monitoring plan. If denied, North Carolina residents can appeal internally

How to Get Uptravi (selexipag) Covered by Aetna (CVS Health) in California: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Uptravi (selexipag) Covered by Aetna (CVS Health) in California Uptravi (selexipag) requires prior authorization from Aetna (CVS Health) with strict clinical criteria. You'll need a pulmonologist or cardiologist to prescribe it, documented WHO Group I PAH diagnosis, and often proof of trying other PAH medications

How to Get Firdapse (Amifampridine) Covered by Aetna CVS Health in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Firdapse Covered by Aetna CVS Health in Texas Aetna CVS Health requires prior authorization for Firdapse (amifampridine) in Texas. To get approved, you need: (1) confirmed LEMS diagnosis with EMG showing ≥60% increment or positive VGCC antibodies, (2) prescription from a neurologist/neuromuscular specialist, and (3) documentation

Work With Your Doctor to Get Rapivab (Peramivir) Approved by Aetna CVS Health in California: Complete Provider Collaboration Guide

Answer Box: Getting Rapivab Covered by Aetna CVS Health in California Rapivab (peramivir) requires prior authorization from Aetna CVS Health in California. The fastest path to approval: work closely with your doctor to submit comprehensive clinical documentation showing you meet FDA criteria (symptom onset ≤48 hours) and cannot take oral/

Oxbryta (Voxelotor) Coverage by Aetna CVS Health in California: 2024 FDA Withdrawal and Your Treatment Options

Answer Box: Oxbryta (Voxelotor) Status and Next Steps Oxbryta (voxelotor) was voluntarily withdrawn from all U.S. markets in September 2024 due to safety concerns. Aetna CVS Health and all insurers no longer authorize this medication. If you were taking Oxbryta, contact your hematologist immediately to discuss alternatives like hydroxyurea,

How Long Does It Take to Get Sylvant (Siltuximab) Approved by Aetna (CVS Health) in Virginia? Complete Timeline & Appeals Guide

Answer Box: Getting Sylvant (Siltuximab) Covered by Aetna (CVS Health) in Virginia Timeline: Aetna (CVS Health) typically decides prior authorization requests for Sylvant (siltuximab) within 14-30 days for standard cases, or 72 hours for urgent requests. After approval, CVS Specialty coordinates the first fill within 2-5 business days. Fastest path:

How to Get Pomalyst (pomalidomide) Covered by Aetna CVS Health in Pennsylvania: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Pomalyst Covered by Aetna CVS Health in Pennsylvania Pomalyst (pomalidomide) requires prior authorization from Aetna CVS Health in Pennsylvania. Your fastest path to approval: (1) Ensure REMS program enrollment is complete, (2) Submit PA request with documented lenalidomide and proteasome inhibitor failure, and (3) Include oncologist attestation.

Do You Qualify for Imbruvica (ibrutinib) Coverage by Aetna (CVS Health) in Ohio? Decision Tree & Next Steps

Answer Box: Quick Eligibility Check You likely qualify for Imbruvica (ibrutinib) coverage by Aetna (CVS Health) in Ohio if you have: * FDA-approved diagnosis (CLL/SLL, Waldenström macroglobulinemia, or chronic GVHD) * Complete pathology confirming your specific condition * Documentation of prior treatment failures (if required by step therapy) Fastest path to approval:

How to Get Raxone (Idebenone) Covered by Aetna CVS Health in North Carolina: Prior Authorization, Appeals & Step-by-Step Guide

Answer Box: Getting Raxone Covered by Aetna CVS Health in North Carolina Raxone (idebenone) is not FDA-approved in the US, making Aetna CVS Health coverage extremely challenging. You'll need a formulary exception request with comprehensive medical necessity documentation from your prescriber. Start by having your doctor submit a