Topic

Aetna (CVS Health)

A collection of 1078 issues

Aetna (CVS Health) Coverage Criteria for Ultomiris (ravulizumab) in New York: What Counts as "Medically Necessary"?

Answer Box: Getting Ultomiris Covered by Aetna (CVS Health) in New York Ultomiris (ravulizumab) requires prior authorization from Aetna (CVS Health) for all FDA-approved indications (PNH, aHUS, anti-AChR+ generalized myasthenia gravis, and NMOSD). Coverage requires meeting diagnosis-specific criteria, meningococcal vaccination, and documentation of clinical necessity. Quick start: 1) Verify your

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

Answer Box: Getting Opdivo Covered by Aetna (CVS Health) in Washington Opdivo (nivolumab) requires prior authorization from Aetna (CVS Health) for all oncology indications in Washington. The fastest path to approval: 1) Verify if your plan uses medical or specialty pharmacy benefit, 2) Complete the Opdivo Injectable Medication Precertification Request

How to Get Opfolda (miglustat) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Opfolda Covered by Aetna CVS Health in Virginia Opfolda (miglustat) requires prior authorization from Aetna CVS Health and must be prescribed with Pombiliti for adults (≥18 years, ≥40 kg) with late-onset Pompe disease who aren't improving on current enzyme replacement therapy. Submit requests via Aetna&

Do You Qualify for Naglazyme (Galsulfase) Coverage by Aetna (CVS Health) in Georgia? Decision Tree & Next Steps

Quick Answer: Your Path to Naglazyme Coverage in Georgia You likely qualify for Naglazyme (galsulfase) coverage through Aetna (CVS Health) if you have confirmed MPS VI diagnosis via enzyme assay or genetic testing, plus documented functional limitations. Aetna requires prior authorization with specialist documentation and baseline assessments (6-minute walk test,

Myths vs. Facts: Getting Enbrel (etanercept) Covered by Aetna (CVS Health) in Michigan

Answer Box: The Reality of Enbrel Coverage in Michigan Myth: If your doctor prescribes Enbrel, Aetna (CVS Health) automatically covers it. Fact: Aetna typically requires prior authorization and often step therapy (trying biosimilar alternatives first) for Enbrel in Michigan. Success depends on proper documentation, not just a prescription. Your fastest

How to Get Firazyr (icatibant injection) Covered by Aetna (CVS Health) in Georgia: Complete Prior Authorization Guide

Answer Box: Getting Firazyr Covered by Aetna (CVS Health) in Georgia Fastest Path to Approval: 1) Have an HAE specialist complete Aetna's Firazyr/icatibant precertification form with confirmed HAE diagnosis and attack history. 2) Submit through CVS Specialty Pharmacy (1-800-237-2767) for processing. 3) If denied, file internal appeal

How to Get Onpattro (patisiran) Covered by Aetna CVS Health in Washington: Complete Prior Authorization and Appeal Guide

Answer Box: Your Fastest Path to Onpattro Coverage To get Onpattro (patisiran) covered by Aetna CVS Health in Washington: Submit the Onpattro precertification form with genetic testing confirming hATTR-PN, baseline mNIS+7 scores, and neurologist evaluation. Aetna typically decides within 5-10 business days. If denied, file internal appeal within 180

Aetna (CVS Health)'s Coverage Criteria for Revlimid (Lenalidomide) in Virginia: What Counts as "Medically Necessary"?

Answer Box: Getting Revlimid (Lenalidomide) Covered by Aetna (CVS Health) in Virginia Aetna (CVS Health) covers Revlimid (lenalidomide) with prior authorization when medically necessary for FDA-approved indications like multiple myeloma and certain lymphomas. To qualify: (1) Submit PA with diagnosis confirmation, prior therapy history, and REMS enrollment proof; (2) Include

Coding That Helps Get Rapivab (Peramivir) Approved by Aetna CVS Health in Michigan: ICD-10, HCPCS J-Code, and NDC Guide

Answer Box: Getting Rapivab (Peramivir) Covered by Aetna CVS Health in Michigan Rapivab (peramivir) requires proper medical benefit coding for Aetna CVS Health approval in Michigan. Use HCPCS J2547 (1 mg per unit), bill 600 units for standard adult dose, pair with ICD-10 J10.1 or J11.1 for uncomplicated

How to Get Kineret (anakinra) Covered by Aetna (CVS Health) in Texas: Complete Guide with Coding, Appeals, and State Protections

Answer Box: Getting Kineret (anakinra) Covered by Aetna (CVS Health) in Texas Aetna (CVS Health) requires prior authorization for Kineret (anakinra) in Texas, with step therapy for RA and specialist attestation for NOMID/CAPS. The fastest path: 1) Submit PA via CVS Specialty with complete therapy history and weight-based dosing