Topic

Aetna (CVS Health)

A collection of 1076 issues

How to Get Aldurazyme (Laronidase) Covered by Aetna (CVS Health) in Michigan: Complete Timeline & Appeals Guide

Answer Box: Getting Aldurazyme Covered by Aetna (CVS Health) in Michigan Aldurazyme (laronidase) requires prior authorization from Aetna (CVS Health) for all Michigan plans. The fastest approval path involves: (1) confirming MPS I diagnosis with genetic/enzyme testing, (2) having your specialist submit complete PA documentation via Availity portal, and

How to Get Raxone (Idebenone) Covered by Aetna CVS Health in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Raxone (Idebenone) Covered by Aetna CVS Health in Ohio Raxone (idebenone) is excluded from Aetna CVS Health formularies but can be covered through a medical exception request for LHON (Leber hereditary optic neuropathy). In Ohio, you have state external review rights after internal appeals. First step today:

How to Get Oxlumo (Lumasiran) Covered by Aetna (CVS Health) in Illinois: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Oxlumo Covered by Aetna (CVS Health) in Illinois Aetna (CVS Health) covers Oxlumo (lumasiran) for primary hyperoxaluria type 1 (PH1) with prior authorization. To get approval: (1) Your nephrologist or geneticist submits a precertification request with confirmed PH1 diagnosis (genetic testing showing AGXT mutation or enzyme analysis)

How to Get Procysbi (cysteamine bitartrate DR) Covered by Aetna (CVS Health) in Ohio: Complete Guide with Forms and Appeal Scripts

Answer Box: Fastest Path to Approval Procysbi requires prior authorization from Aetna (CVS Health) in Ohio. Submit the CVS Caremark PA form with confirmed nephropathic cystinosis diagnosis (ICD-10 E72.04), baseline WBC cystine levels, and monitoring plan. If denied, appeal within 180 days using Ohio's external review process.

How to Get Revlimid (lenalidomide) Covered by Aetna (CVS Health) in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Approval To get Revlimid (lenalidomide) covered by Aetna (CVS Health) in New York: First, ensure your prescriber and pharmacy are enrolled in the mandatory Lenalidomide REMS program. Submit prior authorization through Aetna's provider portal with diagnosis codes, prior therapy documentation, and REMS certification

Myths vs. Facts: Getting Natpara (Parathyroid Hormone) Covered by Aetna CVS Health in Michigan

Important Update: Takeda will permanently discontinue all Natpara shipments on December 31, 2025. New patient starts are typically denied due to no commercial supply. If you're currently on Natpara through the Special Use Program, work with your endocrinologist immediately to plan your transition to alternatives like Yorvipath or

Myths vs. Facts: Getting Gamifant (Emapalumab) Covered by Aetna CVS Health in North Carolina

Answer Box: Getting Gamifant (Emapalumab) Covered by Aetna CVS Health in North Carolina Fastest path to approval: Submit prior authorization through CVS Caremark portal with documented primary HLH diagnosis (HLH-2004 criteria), proof of conventional therapy failure (etoposide + dexamethasone), and hematologist medical necessity letter. If denied, use North Carolina's

Renewing Tepezza (Teprotumumab) Approval with Aetna CVS Health in New York: Complete Guide to Documentation and Timelines

Answer Box: Renewing Tepezza Coverage Most Aetna CVS Health plans limit Tepezza to one 8-infusion course per lifetime. Renewal beyond 8 doses requires exceptional documentation showing unmet clinical need plus peer-reviewed evidence supporting extended treatment. Start renewal requests 2-4 weeks before your final scheduled infusion. If denied, New York residents

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

Quick Answer: Getting Gilenya (Fingolimod) Covered by Aetna (CVS Health) in Texas Aetna requires prior authorization for Gilenya (fingolimod) with documentation of relapsing MS diagnosis, baseline safety tests (EKG, eye exam), and often proof of trying preferred first-line therapies. Your neurologist submits the PA via Aetna's provider portal

Myths vs. Facts: Getting Garadacimab Covered by Aetna (CVS Health) in Washington - Complete Prior Authorization Guide

Answer Box: Getting Garadacimab Covered by Aetna in Washington Garadacimab requires prior authorization from Aetna (CVS Health) with confirmed HAE diagnosis, specialist prescription, and often documented failures of step-therapy alternatives. Washington residents have strong appeal rights through the Office of Insurance Commissioner, including expedited reviews (72 hours) and binding external