Topic

Aetna (CVS Health)

A collection of 1075 issues

Myths vs. Facts: Getting Tecentriq (atezolizumab) Covered by Aetna (CVS Health) in Pennsylvania

Answer Box: Tecentriq (atezolizumab) requires prior authorization from Aetna (CVS Health) in Pennsylvania, with approval based on FDA-indicated use, PD-L1 testing results (≥1% for adjuvant NSCLC, ≥50% for first-line metastatic), and documentation of failed alternatives where required. If denied after internal appeal, Pennsylvania's Independent External Review program offers

How to Get Trikafta (Elexacaftor/Tezacaftor/Ivacaftor) Covered by Aetna CVS Health in Illinois: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Trikafta Covered by Aetna CVS Health in Illinois Aetna CVS Health requires prior authorization for Trikafta (elexacaftor/tezacaftor/ivacaftor) with specific genetic and clinical documentation. You'll need CFTR genotype confirmation, baseline liver tests, and CF specialist consultation. Submit through the Aetna provider portal or call

How to Get Gattex (Teduglutide) Covered by Aetna CVS Health in Ohio: PA Requirements, Appeals & Forms

Answer Box: Getting Gattex Covered by Aetna CVS Health in Ohio Aetna CVS Health covers Gattex (teduglutide) on specialty tiers with prior authorization required for short bowel syndrome patients dependent on parenteral nutrition ≥3 days weekly for ≥12 months. Submit PA via CVS Specialty at (866) 752-7021 with SBS diagnosis,

How to Get Imbruvica (ibrutinib) Covered by Aetna CVS Health in Michigan: Complete Guide to Prior Authorization, Appeals, and Financial Support

Answer Box: Fastest Path to Approval Imbruvica (ibrutinib) requires prior authorization from Aetna CVS Health in Michigan, with no step therapy for CLL/SLL. Your oncologist submits PA documentation (diagnosis, prior treatments, medical necessity) via Aetna's provider portal. Standard decisions take 15 business days; expedited requests 72 hours.

How to Get HyperHEP (Hepatitis B Immune Globulin) Covered by Aetna CVS Health in Florida: Prior Authorization Guide and Appeal Process

Quick Answer: Getting HyperHEP Approved by Aetna CVS Health in Florida HyperHEP (hepatitis B immune globulin) requires prior authorization from Aetna CVS Health in Florida. Submit documentation of hepatitis B exposure within 24 hours, patient anti-HBs levels <10 mIU/mL, and weight-based dosing justification through the Availity portal. If

Get StrataGraft Covered by Aetna CVS Health in New Jersey: Complete Prior Authorization Guide with Forms and Appeals Process

Answer Box: Getting StrataGraft Covered by Aetna CVS Health in New Jersey StrataGraft requires prior authorization from Aetna CVS Health in New Jersey for adults 18+ with deep partial-thickness thermal burns requiring surgical intervention. Submit via the Aetna provider portal using HCPCS code J7353 with burn surgeon documentation. If denied,

How to Get Qinlock (ripretinib) Covered by Aetna CVS Health in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Qinlock Covered by Aetna CVS Health in Florida Qinlock (ripretinib) requires prior authorization from Aetna CVS Health and is classified as non-formulary (Tier 5), requiring documented failure of three prior kinase inhibitors: imatinib, sunitinib, and regorafenib. Your oncologist submits the PA request through the Aetna provider portal

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

Quick Answer: To get Qinlock (ripretinib) covered by Aetna (CVS Health) in North Carolina, you'll need prior authorization showing failure of at least three kinase inhibitors (imatinib, sunitinib, regorafenib) for advanced GIST. Submit requests via Aetna's provider portal or call 1-866-814-5506. Standard decisions take 30 days;

The Complete Requirements Checklist to Get Revlimid (lenalidomide) Covered by Aetna (CVS Health) in Texas

Answer Box: Quick Path to Approval To get Revlimid (lenalidomide) covered by Aetna (CVS Health) in Texas: Submit prior authorization with complete REMS enrollment proof, medical necessity letter documenting failed prior therapies (with specific dates/outcomes), current labs, and NCCN guideline citations. Use Aetna's provider portal for fastest

Do You Qualify for Alprolix Coverage by Aetna CVS Health in Ohio? Decision Tree & Next Steps

Answer Box: Fast Track to Alprolix Coverage Most Ohio patients with hemophilia B qualify for Alprolix coverage through Aetna CVS Health if they have: moderately severe to severe factor IX deficiency (≤2% activity), no inhibitors, hematologist prescription, and documented bleeding episodes or prior therapy failures. Fastest path: Submit prior authorization