Topic

Aetna (CVS Health)

A collection of 1288 issues

How to Get Ozempic and Mounjaro Covered by Aetna CVS Health in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Fastest Path to Approval To get Ozempic or Mounjaro covered by Aetna CVS Health in Florida: Your doctor must submit a prior authorization (PA) request through Aetna's provider portal or by fax, documenting your Type 2 diabetes diagnosis, A1C levels, and failed trials with metformin or

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

Answer Box: Getting Vyondys 53 Covered by Aetna CVS Health in Michigan Aetna CVS Health requires prior authorization for Vyondys 53 (golodirsen) with strict genetic and functional criteria. To get approved in Michigan: (1) Confirm your child has a DMD gene mutation amenable to exon 53 skipping through genetic testing,

Myths vs. Facts: Getting Qinlock (ripretinib) Covered by Aetna (CVS Health) in Texas

Answer Box: Getting Qinlock (ripretinib) Covered by Aetna (CVS Health) in Texas Fastest path to approval: Submit prior authorization through CVS Caremark (1-866-785-5714) with documented failure of 3+ kinase inhibitors including imatinib, FDA-approved GIST diagnosis, and clinical notes supporting fourth-line necessity. First step today: Contact your oncologist to request a

Renewing Advate (octocog alfa) Approval with Aetna CVS Health in New Jersey: Complete Timeline and Documentation Guide

Answer Box: Renewing Advate Coverage in New Jersey Aetna CVS Health requires annual prior authorization renewal for Advate (octocog alfa) in New Jersey, submitted 2-4 weeks before expiration via the Availity portal by your hematologist or hemophilia treatment center (HTC). Essential documents include current factor VIII levels, bleeding logs, weight-based

Renewing Therakos CELLEX Photopheresis Coverage with Aetna (CVS Health) in Illinois: Timeline, Documentation & Appeal Options

Quick Answer: Renewing Your Therakos CELLEX Coverage Aetna (CVS Health) requires prior authorization renewal for Therakos CELLEX photopheresis every 6-12 months. Submit renewal documentation 10-14 days before expiration via Aetna's provider portal, including updated clinical status, treatment response logs, and specialist attestation referencing CPB 0241 criteria. Standard review

How to Get Sylvant (Siltuximab) Covered by Aetna CVS Health in New Jersey: Complete PA Guide & Appeals Process

Answer Box: Getting Sylvant (Siltuximab) Covered by Aetna CVS Health in New Jersey Aetna CVS Health requires prior authorization for Sylvant (siltuximab) for idiopathic multicentric Castleman disease (iMCD), with approval typically taking 14-30 days. Submit via CVS Specialty's Oncology Injectable form with HIV-negative/HHV-8-negative lab results, pathology confirming

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

Quick Answer: Getting Increlex (Mecasermin) Covered by Aetna CVS Health in Florida Aetna CVS Health covers Increlex (mecasermin) for Florida children with severe primary IGF-1 deficiency when specific criteria are met. Your pediatric endocrinologist must submit prior authorization showing height ≥3 standard deviations below normal, IGF-1 levels ≥3 SD below

Renewing Naglazyme (Galsulfase) Approval with Aetna (CVS Health) in Florida: Complete Guide to Prior Authorization Renewal

Answer Box: Renewing Naglazyme (Galsulfase) Coverage with Aetna (CVS Health) in Florida Aetna requires annual prior authorization renewal for Naglazyme (galsulfase) with documented clinical response to therapy. Start your renewal 60-90 days before expiration to avoid treatment gaps. Key requirements include: (1) confirmation of clinically positive response showing improvement, stabilization,

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

Answer Box: Quick Path to Approval Aetna (CVS Health) requires prior authorization for Mepsevii (vestronidase alfa-vjbk) in North Carolina. To get approved: (1) Have a metabolic specialist confirm MPS VII diagnosis via enzyme assay and genetic testing, (2) Submit Aetna's Mepsevii precertification form with lab results and clinical

How to Get Keppra (Levetiracetam) Covered by Aetna (CVS Health) in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Keppra (Levetiracetam) Covered by Aetna (CVS Health) in Georgia Quick Answer: Aetna (CVS Health) requires step therapy for brand Keppra—patients must try generic levetiracetam first. If the generic fails or causes intolerance, your doctor can request prior authorization for brand Keppra through Aetna's provider