Topic

Aetna (CVS Health)

A collection of 651 issues

How to Get Spinraza (nusinersen) Covered by Aetna CVS Health in New York: Complete Guide to Prior Authorization, Appeals, and State External Review

Answer Box: Getting Spinraza (nusinersen) Covered by Aetna CVS Health in New York Spinraza requires prior authorization from Aetna CVS Health in New York but does not require step therapy. To get approved: (1) Ensure genetic confirmation of 5q SMA and baseline motor function testing by a neurologist, (2) Submit

How Long Does It Take to Get Krystexxa (Pegloticase) Approved by Aetna (CVS Health) in New York? Timeline & Milestones

Answer Box: Getting Krystexxa Approved by Aetna in New York Standard timeline: 15-30 days for initial prior authorization; 72 hours for expedited appeals through New York DFS if urgent. Key requirements: G6PD deficiency screening (negative), failed conventional therapy documentation, rheumatologist prescription, and methotrexate co-therapy unless contraindicated. First step: Contact your

How to Get Gamifant (Emapalumab) Covered by Aetna in Florida: Prior Authorization, Appeals, and Step-by-Step Guide

Answer Box: Getting Gamifant Covered by Aetna in Florida Aetna requires prior authorization for Gamifant (emapalumab) in Florida, with strict HLH-2004 diagnostic criteria and step therapy requirements. Your fastest path to approval: (1) Confirm your hematologist has documented at least 5 of 8 HLH-2004 criteria plus conventional therapy failures, (2)

How to Get Eloctate Covered by Aetna CVS Health in Washington: Prior Authorization Guide, Appeals Process, and State Protection Rights

Answer Box: Getting Eloctate Covered by Aetna CVS Health in Washington Eloctate (efmoroctocog alfa) is covered as a preferred specialty drug by Aetna CVS Health in Washington but requires prior authorization from a hematologist. The fastest path to approval: (1) Have your hematologist submit a complete prior authorization with hemophilia

How to Get Ofev (nintedanib) Covered by Aetna (CVS Health) in Ohio: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Ofev Covered by Aetna CVS Health in Ohio Ofev (nintedanib) requires prior authorization from Aetna CVS Health in Ohio. Your pulmonologist must submit documentation including high-resolution chest CT, pulmonary function tests, and specialist attestation. No step therapy is required—approval is diagnosis-driven for IPF, SSc-ILD, or progressive

If Zolgensma Isn't Approved by Aetna CVS Health in Washington: Spinraza, Evrysdi & Exception Paths

Answer Box: When Aetna Denies Zolgensma in Washington If Aetna CVS Health denies Zolgensma (onasemnogene abeparvovec) for your child with SMA, you have two main paths: formulary alternatives (Spinraza, Evrysdi) or formulary exception appeals. Both Spinraza and Evrysdi require prior authorization but have broader age eligibility than Zolgensma's

Renewing Adynovate (bdanocog alfa pegol) Approval with Aetna (CVS Health) in Pennsylvania: Complete Timeline and Documentation Guide

Answer Box: Renewing Adynovate Approval in Pennsylvania Aetna (CVS Health) typically requires prior authorization renewal for Adynovate (bdanocog alfa pegol) every 6-12 months. Start your renewal 30-60 days before expiration to avoid treatment gaps. Submit updated clinical documentation including factor VIII levels, bleeding logs, and treatment response through your hematologist.

Get Kanuma (Sebelipase Alfa) Approved by Aetna CVS Health in North Carolina: Complete Coverage Guide

Quick Answer: Getting Kanuma Covered by Aetna CVS Health in North Carolina Kanuma (sebelipase alfa) requires prior authorization from Aetna CVS Health for LAL-D treatment. Your fastest path to approval: (1) Confirm LAL-D diagnosis with enzyme activity testing and LIPA gene sequencing, (2) Submit PA request via Availity portal with

How to Get Evkeeza (Evinacumab) Approved by Aetna CVS Health in Pennsylvania: Prior Authorization Guide with Appeals Process

Answer Box: Getting Evkeeza Covered by Aetna in Pennsylvania To get Evkeeza (evinacumab-dgnb) approved by Aetna CVS Health in Pennsylvania for homozygous familial hypercholesterolemia (HoFH): 1. Confirm HoFH diagnosis with genetic testing or clinical criteria (untreated LDL-C >400 mg/dL plus family history/xanthomas) 2. Document step therapy failures

Requirements Checklist to Get Brineura (cerliponase alfa) Covered by Aetna (CVS Health) in Washington

Answer Box: Getting Started Aetna (CVS Health) requires prior authorization for Brineura (cerliponase alfa) with strict clinical criteria. Your fastest path to approval: confirm CLN2 diagnosis with genetic/enzyme testing, ensure treatment by a metabolic specialist at an approved infusion center, and submit complete documentation showing motor function assessment. Start