Topic

Aetna (CVS Health)

A collection of 653 issues

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

Work With Your Doctor to Get Jaypirca (Pirtobrutinib) Approved by Aetna (CVS Health) in North Carolina

Answer Box: Getting Jaypirca Covered by Aetna in North Carolina Jaypirca (pirtobrutinib) requires prior authorization from Aetna (CVS Health) in North Carolina. Your fastest path to approval: work directly with your oncologist to document prior BTK inhibitor failure and submit a comprehensive medical necessity letter. If denied, North Carolina'

Do You Qualify for Fintepla (Fenfluramine) Coverage by Aetna (CVS Health) in California? Decision Tree & Next Steps

Answer Box: Quick Qualification Check To qualify for Fintepla (fenfluramine) coverage by Aetna (CVS Health) in California: You need a confirmed diagnosis of Dravet syndrome or Lennox-Gastaut syndrome (LGS) from a neurologist, documented failure of at least two standard antiseizure medications, enrollment in the FDA REMS program with baseline echocardiogram,

How to Get Trikafta Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide 2024

Answer Box: Getting Trikafta Covered by Aetna CVS Health in Virginia Trikafta requires prior authorization from Aetna CVS Health in Virginia. Submit complete documentation including CFTR genotype testing showing F508del mutation, CF diagnosis with ICD-10 codes E84.0-E84.9, and baseline liver function tests. If denied, appeal within 180 days

How to Get Lutathera Covered by Aetna in Michigan: Prior Authorization Forms, Timelines & Appeals Guide

Quick Answer: Getting Lutathera Covered by Aetna in Michigan Lutathera (lutetium Lu-177 dotatate) requires prior authorization from Aetna in Michigan. The fastest path to approval: (1) Complete Aetna's Lutathera Precertification Form with detailed clinical documentation including SSTR-positive imaging, (2) Submit via Availity portal or fax to 1-888-267-3277 at

Lowering Out-of-Pocket Costs for Acthar Gel with Aetna CVS Health in Michigan: Complete Coverage & Assistance Guide

Answer Box: Getting Acthar Gel Covered by Aetna CVS Health in Michigan Acthar Gel requires prior authorization from Aetna CVS Health in Michigan, with strict step therapy requiring documented failure of corticosteroids first. Your fastest path to approval: (1) Gather complete records of prior corticosteroid trials and outcomes, (2) Have

Firazyr (icatibant injection) Approval with Aetna (CVS Health) in Florida: Complete Guide with Forms and Appeal Scripts

Quick Answer: Getting Firazyr Covered by Aetna in Florida Yes, Firazyr (icatibant) is covered by Aetna CVS Health for acute HAE attacks in Florida members. The fastest path: 1) Have your HAE specialist submit prior authorization with confirmed C1-INH deficiency labs and self-administration training documentation, 2) Submit through CVS Caremark

The Requirements Checklist to Get Hemlibra (emicizumab-kxwh) Covered by Aetna (CVS Health) in Ohio

Answer Box: Getting Hemlibra Covered by Aetna in Ohio Hemlibra (emicizumab-kxwh) requires prior authorization from Aetna (CVS Health) for hemophilia A prophylaxis. You must be prescribed by a hematologist, document failure of factor VIII prophylaxis (step therapy), and provide weight-based dosing plans. The fastest path: gather bleeding history, factor VIII

Myths vs. Facts: Getting Palynziq (pegvaliase-pqpz) Covered by Aetna CVS Health in Illinois

Quick Answer: Getting Palynziq Covered by Aetna CVS Health in Illinois Aetna CVS Health covers Palynziq (pegvaliase-pqpz) for PKU patients in Illinois when strict prior authorization criteria are met: confirmed PKU diagnosis, blood phenylalanine >600 µmol/L, documented failure of dietary management and/or sapropterin, and REMS program enrollment.