Topic

Aetna (CVS Health)

A collection of 1288 issues

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

Answer Box: Getting Photrexa Covered by Aetna CVS Health in Texas Aetna CVS Health covers Photrexa (riboflavin ophthalmic solution) for corneal cross-linking in progressive keratoconus, but requires prior authorization with documented progression. Key requirements: serial corneal topography showing ≥1 diopter Kmax increase over 12 months, minimum corneal thickness ≥400 microns,
6 min read

Renewing Elevidys (Delandistrogene Moxeparvovec-Rokl) Approval with Aetna CVS Health in California: What to Prepare & When

Answer Box: Elevidys Renewal Essentials Elevidys (delandistrogene moxeparvovec-rokl) is a one-time gene therapy, so traditional "renewal" doesn't apply. However, California DMD families may need ongoing coverage for monitoring labs, cardiac assessments, and potential complications. Start preparing 90 days before your plan year changes by documenting treatment
5 min read

Getting Blenrep (Belantamab Mafodotin) Covered by Aetna (CVS Health) in Washington: Complete Access Guide for Current and Future Approval

Answer Box: Current Blenrep Access Through Aetna in Washington Blenrep (belantamab mafodotin) is not commercially available through standard Aetna coverage due to its 2022 FDA withdrawal, with re-approval anticipated October 2025. Current access requires clinical trial enrollment or GSK expanded access programs. Washington residents denied coverage can appeal through Aetna&
5 min read

How to Get Blenrep (belantamab mafodotin) Covered by Aetna (CVS Health) in Pennsylvania: Appeals Guide with Forms and Timelines

Answer Box: Getting Blenrep Covered in Pennsylvania Blenrep (belantamab mafodotin) received FDA approval on October 23, 2025, for adults with relapsed or refractory multiple myeloma. Aetna (CVS Health) requires prior authorization through CVS Caremark for this specialty drug. If denied, Pennsylvania's external review program overturns approximately 50% of
7 min read

How to Get Idelvion Covered by Aetna CVS Health in New Jersey: Prior Authorization Guide and Appeals Process

Answer Box: Getting Idelvion Covered by Aetna CVS Health in New Jersey Idelvion (albutrepenonacog alfa; rFIX-FP) requires prior authorization from Aetna CVS Health for hemophilia B treatment. Key requirements: confirmed Factor IX deficiency ≤2%, negative inhibitors (<0.6 BU), board-certified hematologist prescription, and specialty pharmacy dispensing through CVS Caremark.
6 min read

How to Get Helixate (Antihemophilic Factor, rFVIII) Covered by Aetna CVS Health in Washington: Complete Appeals Guide

Answer Box: Fast Track to Helixate Coverage Getting Helixate (antihemophilic factor, rFVIII) covered by Aetna CVS Health in Washington requires prior authorization through CVS Caremark specialty pharmacy. Start with your hematologist submitting a complete PA request via Aetna's Availity portal including confirmed hemophilia A diagnosis, factor VIII levels,
7 min read