Topic

Aetna (CVS Health)

A collection of 144 issues

How to Get Cosentyx (Secukinumab) Covered by Aetna CVS Health in Pennsylvania: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Cosentyx Covered by Aetna CVS Health in Pennsylvania Aetna CVS Health requires prior authorization for Cosentyx (secukinumab) in Pennsylvania, with step therapy requirements for most patients. Fastest path to approval: 1) Ensure TB screening is complete, 2) Document prior treatment failures (typically methotrexate or other biologics), and

How to Get Orkambi (lumacaftor/ivacaftor) Covered by Aetna CVS Health in Florida: Complete Approval Guide

Quick Answer: Getting Orkambi Covered by Aetna CVS Health in Florida Aetna CVS Health requires prior authorization for Orkambi (lumacaftor/ivacaftor) in Florida. Your fastest path to approval: (1) Confirm F508del homozygous mutation documentation, (2) Submit complete prior authorization via Availity provider portal with CF diagnosis and failed therapy history,

How to Get Trikafta Covered by Aetna CVS Health in Ohio: Prior Authorization Forms, Appeal Process & Alternatives

Answer Box: Getting Trikafta Covered by Aetna CVS Health in Ohio Fastest Path: Aetna CVS Health covers Trikafta with prior authorization requiring CFTR genetic testing showing ≥1 F508del mutation, baseline labs, and CF specialist prescription. Submit PA via fax (1-888-267-3277) or phone (1-855-240-0535). If denied, you have 180 days to

How to Get Vigabatrin (Sabril) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization Guide

Answer Box: Getting Vigabatrin Covered by Aetna CVS Health in Virginia Fast track to approval: Vigabatrin requires prior authorization from Aetna CVS Health with mandatory REMS enrollment for prescriber, patient, and pharmacy. Document two failed antiepileptic drugs, complete baseline vision testing, and submit through CVS Specialty Pharmacy. If denied, Virginia&

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

Answer Box: Quick Start for Florida Patients To get Jynarque (tolvaptan) covered by Aetna (CVS Health) in Florida, you need prior authorization documenting rapidly progressing ADPKD with Mayo Classification 1C-1E and eGFR decline ≥3.0 mL/min/1.73 m²/year. Your nephrologist must enroll in the REMS program and

How to Get Translarna (Ataluren) Covered by Aetna CVS Health in Michigan: Complete Requirements Guide

Quick Answer: Getting Translarna Covered by Aetna CVS Health in Michigan Translarna (ataluren) requires prior authorization from Aetna CVS Health in Michigan. The fastest path to approval: (1) Submit PA request through Availity portal with genetic testing confirming nonsense mutation DMD, (2) Include ambulatory status documentation and medical necessity letter,

How to Get Sumavel DosePro Covered by Aetna (CVS Health) in Washington: Complete Prior Authorization Guide

Quick Answer: Getting Sumavel DosePro Covered by Aetna (CVS Health) in Washington Sumavel DosePro requires prior authorization from Aetna CVS Health in Washington. You'll need documented failure or intolerance to oral triptans first (step therapy). Your doctor submits a PA request with clinical notes, ICD-10 codes (G43.x

Renewing Lutathera (Lutetium Lu-177 Dotatate) Approval with Aetna CVS Health in Texas: Timeline, Documents, and Bridge Options

Answer Box: Renewing Your Lutathera Approval Lutathera (lutetium Lu-177 dotatate) renewal with Aetna CVS Health in Texas requires documentation of continued clinical benefit before completing all 4 doses. Most patients receive initial approval for the full 4-dose course, but if treatment was interrupted or you need continuation authorization, submit clinical

How to Get Strensiq (asfotase alfa) Covered by Aetna CVS Health in North Carolina: Appeals Guide & Templates

Answer Box: Getting Strensiq Covered by Aetna CVS Health in North Carolina Aetna CVS Health covers Strensiq (asfotase alfa) for pediatric-onset hypophosphatasia with prior authorization. Key requirements: ALPL gene mutation OR low alkaline phosphatase plus elevated substrates, proof of onset before age 18, and specialist prescription. If denied, you have

How to Get Lamzede (velmanase alfa-tycv) Covered by Aetna in North Carolina: PA Requirements, Appeals, and Smart NC External Review

Quick Answer: Getting Lamzede Covered by Aetna in North Carolina Aetna requires prior authorization for Lamzede (velmanase alfa-tycv) in 2024. To get coverage, you need: confirmed alpha-mannosidosis diagnosis (enzyme deficiency or MAN2B1 genetic testing), specialist prescriber, and clinical documentation. If denied, North Carolina's Smart NC program offers external