Topic

Aetna (CVS Health)

A collection of 1077 issues

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

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

Quick Answer: To get Kalydeco (ivacaftor) covered by Aetna (CVS Health) in Ohio, you need prior authorization with CFTR genetic testing proving an FDA-responsive mutation, CF specialist prescription, and clinical documentation. If denied, use Ohio's external review process within 180 days. Start by gathering your genetic test results

How to Get Mepsevii (vestronidase alfa-vjbk) Covered by Aetna (CVS Health) in California: Prior Authorization Guide and Appeal Process

Answer Box: Getting Mepsevii Covered by Aetna (CVS Health) in California Mepsevii (vestronidase alfa-vjbk) requires prior authorization from Aetna with strict medical necessity criteria. Success requires: (1) confirmed MPS VII diagnosis via enzyme assay or genetic testing, (2) elevated urinary GAGs ≥2× normal, and (3) prescription by a metabolic specialist.

Work With Your Doctor to Get Amvuttra (vutrisiran) Approved by Aetna CVS Health in Texas: Complete Provider Collaboration Guide

Answer Box: Getting Amvuttra (vutrisiran) Approved by Aetna CVS Health in Texas Amvuttra (vutrisiran) requires prior authorization from Aetna CVS Health for both hATTR polyneuropathy and ATTR cardiomyopathy. Success depends on partnering with your neurologist or cardiologist to submit comprehensive documentation including genetic testing, tissue diagnosis, and symptom scores. If

How Long Does It Take to Get Fintepla (Fenfluramine) Approved by Aetna (CVS Health) in New Jersey? Complete Timeline & Appeals Guide

Answer Box: Getting Fintepla Approved by Aetna (CVS Health) in New Jersey Standard timeline: 15-30 days for prior authorization; 72 hours for urgent cases. Aetna requires documented failure of ≥2 preferred antiseizure medications, REMS enrollment (prescriber and patient), and baseline echocardiogram for Dravet syndrome or Lennox-Gastaut syndrome patients ≥2 years

How to Get Koselugo (selumetinib) Covered by Aetna (CVS Health) in Florida: Complete Prior Authorization Guide

Answer Box: Getting Koselugo (selumetinib) Covered by Aetna (CVS Health) in Florida Koselugo (selumetinib) is typically covered by Aetna (CVS Health) as a specialty medication with prior authorization for pediatric patients ≥2 years with NF1 and symptomatic, inoperable plexiform neurofibromas. The fastest path to approval: 1) Have your pediatric oncologist

Myths vs. Facts: Getting Orfadin (nitisinone) Covered by Aetna (CVS Health) in Virginia

Quick Answer: Aetna (CVS Health) requires prior authorization for Orfadin (nitisinone) with documented HT-1 diagnosis via elevated succinylacetone, dietary management plan, and weight-based dosing justification. Appeals must be filed within 180 days, with Virginia's external review available through the State Corporation Commission. Start by gathering lab results, genetic

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

Answer Box: Getting Tegsedi (Inotersen) Covered by Aetna CVS Health in Illinois Tegsedi (inotersen) requires prior authorization from Aetna CVS Health for hATTR polyneuropathy coverage in Illinois. Key requirements: confirmed TTR gene mutation, documented polyneuropathy symptoms, specialist prescription (neurologist/geneticist), and REMS program enrollment. Submit via Aetna provider portal with

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

Quick Answer: Getting Tavalisse Approved by Aetna CVS Health in California Aetna CVS Health requires prior authorization for Tavalisse (fostamatinib) with strict step therapy criteria including documented failure of corticosteroids, IVIG, and TPO receptor agonists. Your fastest path: Have your hematologist submit a complete PA request via the Aetna provider

How to Get Mycapssa (Octreotide Oral) Covered by Aetna CVS Health in North Carolina: Appeals, Prior Authorization, and State Protections

Answer Box: Getting Mycapssa Covered by Aetna CVS Health in North Carolina Fastest path to approval: Submit prior authorization through CVS Specialty (1-800-237-2767) with documented acromegaly diagnosis, prior response to injectable octreotide/lanreotide, and medical necessity letter. If denied, file internal appeal within 180 days citing North Carolina step therapy