Topic

Aetna (CVS Health)

A collection of 144 issues

How to Get Gilenya (fingolimod) Covered by Aetna in New York: 2025 Prior Authorization Guide

Answer Box: Getting Gilenya Covered by Aetna in New York Aetna requires prior authorization for Gilenya (fingolimod) with specific criteria: relapsing MS diagnosis, neurologist prescription, age 10+, and documented safety monitoring plan. First step: Have your neurologist submit a PA request through Aetna's Availity portal with complete medical

How to Get Xywav (Ca/Mg/K/Na Oxybates) Covered by Aetna CVS Health in North Carolina: Complete Guide to Prior Authorization, Appeals, and External Review

Quick Answer: Xywav requires prior authorization from Aetna CVS Health in North Carolina. You'll likely need to try modafinil or armodafinil first (step therapy), then your doctor must submit clinical documentation proving medical necessity. If denied, you can appeal internally twice, then request external review through North Carolina&

How to Get Isturisa (Osilodrostat) Covered by Aetna CVS Health in California: Forms, Appeals, and Alternatives

Answer Box: Getting Isturisa Covered by Aetna CVS Health in California Isturisa (osilodrostat) is non-formulary on Aetna CVS Health Standard plans for 2025, requiring a medical exception request with strong clinical documentation. Your fastest path: 1) Have your endocrinologist submit a prior authorization with UFC test results and surgical history,

How to Get Mycapssa (Octreotide) Covered by Aetna CVS Health in Ohio: Complete Prior Authorization Guide

Answer Box: Getting Mycapssa Covered by Aetna CVS Health in Ohio Mycapssa (oral octreotide) requires prior authorization from Aetna CVS Health and is only approved for acromegaly patients who have already responded to injectable octreotide or lanreotide. The fastest path to approval: 1) Gather documentation of your prior response to

How Long Does It Take to Get Vigabatrin (Sabril) Approved by Aetna CVS Health in Georgia? Complete Timeline Guide

Answer Box: Getting Vigabatrin Approved by Aetna CVS Health in Georgia Standard timeline: 7 days for routine requests, 72 hours for urgent cases. The fastest path requires complete REMS enrollment, baseline vision testing documentation, and specialist involvement. Most approvals happen within 24 hours when submitted electronically with all required documents.

Getting Imbruvica (Ibrutinib) Covered by Aetna CVS Health in Virginia: Forms, Appeals, and Step Therapy Rights

Quick Answer: Your Path to Approval Imbruvica (ibrutinib) requires prior authorization from Aetna CVS Health but no step therapy for CLL/SLL. In Virginia, you have strong appeal rights: 72-hour step therapy override decisions, 180 days to appeal denials, and external review through the State Corporation Commission using Form 216-A.

How to Get Zolgensma Covered by Aetna CVS Health in Michigan: Complete Appeals Guide with Forms and Deadlines

Answer Box: Getting Zolgensma Covered by Aetna CVS Health in Michigan Fastest path to approval: Submit prior authorization through Aetna's provider portal with genetic confirmation of SMA, age verification (under 2 years), and detailed medical necessity letter. If denied, file internal appeal within 60 days, then request expedited

Myths vs. Facts: Getting HyperHEP (Hepatitis B Immune Globulin) Covered by Aetna (CVS Health) in New Jersey

Answer Box: Getting HyperHEP Covered by Aetna (CVS Health) in New Jersey Good news: HyperHEP (hepatitis B immune globulin) is typically covered by Aetna for post-exposure prophylaxis when medically necessary. Key facts: Prior authorization isn't routinely required for emergency post-exposure use, but documentation of exposure and vaccination history

How to Get Zolgensma Covered by Aetna in Texas: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Zolgensma Covered by Aetna in Texas Aetna requires prior authorization for Zolgensma (onasemnogene abeparvovec) in Texas. Your child must be under 2 years old with genetic confirmation of SMA (bi-allelic SMN1 mutations). The fastest path: 1) Have your neurologist submit prior authorization with genetic test results, 2)

Get Soliris (Eculizumab) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization Guide

Answer Box: Fastest Path to Soliris Coverage Getting Soliris (eculizumab) covered by Aetna CVS Health in North Carolina requires meeting strict diagnostic criteria and completing mandatory vaccinations. Step 1: Confirm your diagnosis with required lab tests (flow cytometry for PNH, anti-AChR antibodies for myasthenia gravis). Step 2: Complete meningococcal vaccination