Topic

Aetna (CVS Health)

A collection of 1288 issues

How to Get Humira (adalimumab) Covered by Aetna (CVS Health) in Pennsylvania: 2024 Forms, Appeals & Contact Guide

Answer Box: Getting Humira Covered by Aetna in Pennsylvania Pennsylvania Aetna members need prior authorization for Humira (adalimumab), but benefit from the state's step therapy exemption for fully insured plans. Submit the Aetna precertification form with TB screening and prior therapy documentation. If denied, appeal within 60 days

Coding That Helps Get Zokinvy (Lonafarnib) Approved in Illinois with Aetna (CVS Health): ICD-10, HCPCS/J-Code, NDC

Answer Box Zokinvy (lonafarnib) requires prior authorization from Aetna (CVS Health) using ICD-10 code E34.8 (progeria), HCPCS J8499, and specific NDCs (60923-0544-53, 73079-0050-30). Submit genetic confirmation, BSA calculations, and specialist oversight through CVS Specialty Pharmacy. Illinois residents have 4 months to file external appeals through the Illinois Department of

How to Get Elfabrio (pegunigalsidase alfa-iwxj) Covered by Aetna (CVS Health) in California: Complete Forms, Appeals & Contact Guide

Answer Box: Getting Elfabrio Covered by Aetna (CVS Health) in California Aetna (CVS Health) requires prior authorization for Elfabrio (pegunigalsidase alfa-iwxj) with confirmed Fabry disease diagnosis, specialist prescriber, and weight-based dosing documentation. Submit through CVS Specialty enrollment forms or Aetna provider portal. If denied, file internal appeal within 180 days,

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

Answer Box: Getting Photrexa Covered by Aetna CVS Health in New York Yes, Aetna CVS Health covers Photrexa (riboflavin ophthalmic solution) for progressive keratoconus with prior authorization. To get approved in New York: (1) Your cornea specialist submits prior authorization with serial topography showing progression, (2) Aetna typically decides within

How to Get Zokinvy (lonafarnib) Covered by Aetna in Texas: Complete PA Guide with Appeals Process

Answer Box: Getting Zokinvy Covered by Aetna in Texas Zokinvy (lonafarnib) requires prior authorization from Aetna with specialty pharmacy dispensing through CVS Specialty. Submit PA with genetic confirmation (LMNA variant for HGPS), baseline ECG showing QTc ≤500ms, and specialist documentation. If denied, Texas law provides internal appeals (180 days) and

How to Get Krystexxa (Pegloticase) Covered by Aetna CVS Health in California: Complete Prior Authorization and Appeals Guide

Answer Box: Get Krystexxa Covered by Aetna CVS Health in California Krystexxa (pegloticase) requires prior authorization from Aetna CVS Health for chronic gout patients who've failed allopurinol AND febuxostat. Submit complete documentation including G6PD test results, prior therapy records, and rheumatologist notes via medical benefit (J2507). If denied,

How to Get Imbruvica (ibrutinib) Covered by Aetna (CVS Health) in Pennsylvania: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Imbruvica Covered by Aetna in Pennsylvania Aetna (CVS Health) requires prior authorization for Imbruvica (ibrutinib) but does not mandate step therapy for CLL/SLL. Standard approval takes 15 business days; expedited requests are processed within 72 hours. If denied, you have 180 days to appeal internally, followed

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

Answer Box: Getting Oxervate Covered by Aetna CVS Health in Texas Oxervate (cenegermin) is covered by Aetna CVS Health as a non-preferred specialty drug requiring prior authorization and step therapy. For Stage 2-3 neurotrophic keratitis patients ≥2 years old, you'll need documented failure of preservative-free artificial tears and

How to Get Kesimpta (Ofatumumab) Covered by Aetna (CVS Health) in Michigan: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Kesimpta Covered by Aetna (CVS Health) in Michigan Aetna (CVS Health) requires prior authorization for Kesimpta (ofatumumab) in Michigan, typically after failure of 2-3 formulary disease-modifying therapies including an interferon or glatiramer acetate. Your neurologist must document relapsing MS diagnosis, prior therapy failures, hepatitis B screening, and

Do You Qualify for Acthar Gel Coverage by Aetna CVS Health in Texas? Decision Tree & Next Steps

Answer Box: Acthar Gel Coverage by Aetna CVS Health in Texas Yes, you can get Acthar Gel covered by Aetna CVS Health in Texas, but prior authorization is required for all uses. Your best path to approval: 1. Confirm eligibility: Infantile spasms (under 24 months) or MS exacerbations after steroid