Topic

Aetna (CVS Health)

A collection of 142 issues

How to Get Adynovate (Antihemophilic Factor VIII) Covered by Aetna CVS Health in Michigan: Prior Authorization Forms, Appeals, and Documentation Requirements

Answer Box: Getting Adynovate Covered by Aetna CVS Health in Michigan To get Adynovate (bdanocog alfa pegol) covered by Aetna CVS Health in Michigan: 1. Submit prior authorization via CVS Caremark specialty fax at 1-888-267-3277 or call 1-855-240-0535 2. Document medical necessity including hemophilia A severity (ICD-10: D66) and why

How to Get Upstaza (Eladocagene Exuparvovec) Covered by Aetna in Ohio: Prior Authorization, Appeals, and State Protections

Quick Answer: Getting Upstaza Covered by Aetna in Ohio Upstaza (eladocagene exuparvovec) requires prior authorization from Aetna in Ohio, with genetic confirmation of AADC deficiency and specialty pharmacy fulfillment. If denied, you have 180 days for internal appeals, then external review through Ohio Department of Insurance. Start with your prescriber

How to Get Enbrel (Etanercept) Covered by Aetna CVS Health in Georgia: Appeals, Forms, and State Protections

Answer Box: Getting Enbrel Covered by Aetna CVS Health in Georgia Aetna CVS Health requires prior authorization for Enbrel (etanercept) in Georgia and typically mandates step therapy with biosimilar alternatives first. Your fastest path to approval: gather documentation of failed conventional DMARDs (like methotrexate), submit prior authorization through CVS Specialty

Get Strensiq (Asfotase Alfa) Approved by Aetna CVS Health in Ohio: Complete Coverage Guide

Answer Box: Quick Start Guide Yes, Aetna CVS Health covers Strensiq (asfotase alfa) for hypophosphatasia in Ohio with prior authorization. You need documented perinatal/infantile or juvenile-onset HPP with genetic confirmation (ALPL mutation) or biochemical proof (low alkaline phosphatase + elevated substrates + skeletal abnormalities). Your doctor submits the precertification request to

How to Get Cabometyx (Cabozantinib) Covered by Aetna CVS Health in Virginia: PA Requirements, Appeal Process & Forms

Answer Box: Getting Cabometyx Covered by Aetna CVS Health in Virginia Key Challenge: Cabometyx (cabozantinib) is excluded from Aetna's 2024 Advanced Control formulary, meaning standard coverage is denied. However, Virginia patients can pursue a formulary exception through Aetna's medical necessity process. Fastest Path to Approval: 1.

Get Cresemba (Isavuconazole) Covered by Aetna CVS Health in Washington: Forms, Appeals & Support

Answer Box: Getting Cresemba Covered by Aetna CVS Health in Washington Yes, Aetna CVS Health covers Cresemba (isavuconazole) with prior authorization for invasive aspergillosis and mucormycosis. The fastest path: submit a complete PA request through CVS Caremark's electronic portal with diagnosis documentation, prior antifungal trials, and infectious disease

Getting Pyrukynd (Mitapivat) Covered by Aetna CVS Health in Virginia: Complete Guide to Prior Authorization and Appeals

Answer Box: Your Path to Pyrukynd Coverage Getting Pyrukynd (mitapivat) covered by Aetna CVS Health in Virginia requires prior authorization with strict genetic and clinical criteria. You'll need confirmed pyruvate kinase deficiency with at least two PKLR gene variants (one missense), hemoglobin ≤10 g/dL or significant transfusion

How to Get Imbruvica (ibrutinib) Covered by Aetna CVS Health in Texas: Prior Authorization, Appeals, and Step-by-Step Guide

Answer Box: Getting Imbruvica Covered by Aetna CVS Health in Texas Imbruvica (ibrutinib) requires prior authorization from Aetna CVS Health but typically doesn't require step therapy for CLL/SLL or Waldenström macroglobulinemia. Your fastest path to approval: 1) Have your oncologist submit a prior authorization with diagnosis confirmation

How to Get Carbaglu (carglumic acid) Covered by Aetna (CVS Health) in Texas: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Carbaglu (carglumic acid) Covered by Aetna (CVS Health) in Texas Fastest path to approval: Aetna (CVS Health) requires prior authorization for Carbaglu with documented NAGS deficiency, elevated plasma ammonia levels, and genetic/biochemical testing. First step today: Have your prescriber submit a PA request via Aetna'

Myths vs. Facts: Getting Cabometyx (Cabozantinib) Covered by Aetna CVS Health in Texas

Answer Box: Getting Cabometyx Covered by Aetna CVS Health in Texas Eligibility: Cabometyx requires prior authorization for FDA-approved indications (renal cell carcinoma, hepatocellular carcinoma, differentiated thyroid cancer). Fastest path: Submit complete PA request through Availity portal with medical necessity letter, imaging with RECIST criteria, and prior therapy documentation. First step