Topic

Aetna (CVS Health)

A collection of 1288 issues

How to Get Orfadin (nitisinone) Covered by Aetna CVS Health in North Carolina: Complete PA Guide with Appeals Timeline

Answer Box: Getting Orfadin (nitisinone) Covered by Aetna CVS Health in North Carolina Aetna CVS Health requires prior authorization for Orfadin (nitisinone) with approval contingent on confirmed hereditary tyrosinemia type 1 (HT-1) diagnosis, elevated succinylacetone levels, and documented dietary management. Standard decisions take 72 hours; expedited requests get 24-hour responses.

Do You Qualify for Venclexta (venetoclax) Coverage by Aetna (CVS Health) in Ohio? Decision Tree & Next Steps

Answer Box: Your Path to Venclexta Coverage in Ohio If you have CLL/SLL or AML and meet FDA criteria, you likely qualify for Venclexta coverage by Aetna (CVS Health) in Ohio. The fastest path: (1) Document BTK inhibitor failure for CLL cases, (2) Complete TLS prevention plan with baseline

How to Get Juxtapid (Lomitapide) Covered by Aetna CVS Health in Pennsylvania: Complete Prior Authorization Guide

Answer Box: Getting Juxtapid (Lomitapide) Covered by Aetna CVS Health in Pennsylvania Juxtapid (lomitapide) requires prior authorization from Aetna CVS Health for homozygous familial hypercholesterolemia (HoFH) treatment in Pennsylvania. Submit requests through CVS Caremark's ePA portal at Availity.com or fax to 1-866-249-6155. Key requirements: genetic HoFH confirmation,

How to Get Jaypirca (Pirtobrutinib) Covered by Aetna CVS Health in Texas: Prior Authorization, Appeals, and State IRO Process

Answer Box: Getting Jaypirca (Pirtobrutinib) Covered by Aetna CVS Health in Texas Yes, Aetna CVS Health covers Jaypirca (pirtobrutinib) in Texas with prior authorization for FDA-approved indications. The fastest path: Your hematologist/oncologist submits a PA request via Availity portal with documentation of prior BTK inhibitor failure and medical necessity.

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

Quick Answer: Getting Kesimpta Covered by Aetna CVS Health in Illinois Kesimpta (ofatumumab) requires prior authorization from Aetna CVS Health for relapsing multiple sclerosis. Submit through the CVS Specialty Pharmacy portal with neurologist prescription, documented prior DMT failures, HBV screening, and vaccination records. Standard review takes 30-45 days; expedited review

How to Get Vyondys 53 (Golodirsen) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Vyondys 53 Covered by Aetna CVS Health in Virginia Eligibility: Patients with confirmed Duchenne muscular dystrophy (DMD) and a genetic mutation amenable to exon 53 skipping. Fastest approval path: Submit prior authorization through your DMD specialist with genetic testing, baseline assessments, and corticosteroid documentation. Start today: Contact

Myths vs. Facts: Getting Tagrisso (osimertinib) Covered by Aetna (CVS Health) in Virginia

Answer Box: Getting Tagrisso (osimertinib) Covered by Aetna (CVS Health) in Virginia Aetna (CVS Health) requires prior authorization for all Tagrisso prescriptions, mandating documented EGFR mutation testing and oncology specialist prescriber. Standard review takes 30-45 days; expedited appeals (with physician urgency statement) complete within 72 hours. If denied, Virginia'

How Long Does It Take to Get Krystexxa (Pegloticase) Approved by Aetna (CVS Health) in New Jersey? Timeline & Appeal Process

Answer Box: Fastest Path to Approval Getting Krystexxa (pegloticase) approved by Aetna (CVS Health) in New Jersey typically takes 3-15 business days for prior authorization, depending on documentation completeness. Key requirements include rheumatologist prescriber, documented failure of allopurinol and febuxostat (3+ months each), G6PD test results, and methotrexate co-therapy plan.

Do You Qualify for Arikayce (Amikacin Liposome Inhalation) Coverage by Aetna (CVS Health) in Illinois? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Arikayce Coverage in Illinois To get Arikayce (amikacin liposome inhalation) covered by Aetna (CVS Health) in Illinois, you need: (1) confirmed refractory MAC lung disease with ≥6 months of failed multidrug therapy and persistent positive cultures, (2) prior authorization through Aetna's Clinical

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

Answer Box: Getting Eloctate Covered by Aetna CVS Health in Texas Eloctate (efmoroctocog alfa) requires prior authorization from Aetna CVS Health in Texas. To qualify, you need confirmed hemophilia A with factor VIII deficiency, documented bleeding episodes, and clinical justification for extended half-life therapy. Start today: Have your hematologist submit