Topic

Aetna (CVS Health)

A collection of 1288 issues

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

Answer Box: Getting Pomalyst (pomalidomide) Covered by Aetna (CVS Health) in Georgia Pomalyst requires prior authorization from Aetna (CVS Health) in Georgia. The fastest path: (1) Ensure prescriber and patient are enrolled in the POMALYST REMS program with authorization number, (2) Submit PA via Availity provider portal with documented lenalidomide

How to Get Mavenclad (Cladribine Tablets) Covered by Aetna CVS Health in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Mavenclad Covered by Aetna CVS Health in Ohio Fastest path to approval: Aetna CVS Health covers Mavenclad (cladribine tablets) for relapsing multiple sclerosis with prior authorization requiring documented failure of ≥2 prior DMTs, baseline lymphocyte count ≥800 cells/µL, and neurologist prescription. Standard PA decisions within 72

How to Get Keytruda (Pembrolizumab) Covered by Aetna (CVS Health) in Ohio: Complete PA Guide with Forms and Appeal Scripts

Answer Box: Getting Keytruda Covered by Aetna in Ohio Prior authorization is required for Keytruda (pembrolizumab) on all Aetna CVS Health plans in Ohio. The fastest path to approval: (1) Have your oncologist submit Aetna's Keytruda precertification form with complete biomarker results and prior therapy documentation, (2) Include

How to Get Tracleer (bosentan) Covered by Aetna (CVS Health) in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tracleer (bosentan) Covered by Aetna (CVS Health) in New York Aetna (CVS Health) requires prior authorization and typically step therapy for Tracleer (bosentan), treating it as a non-formulary specialty drug. Success requires: 1) Complete Bosentan REMS enrollment for both prescriber and patient, 2) Document failure/intolerance of

Getting Berinert (C1-Esterase Inhibitor) Covered by Aetna CVS Health in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: How to Get Berinert Covered by Aetna CVS Health in Georgia Aetna requires prior authorization for Berinert (C1-esterase inhibitor, IV) with specific medical necessity criteria. To get approval: 1) Submit PA through Aetna's electronic portal with HAE diagnosis confirmation (low C4, abnormal C1-INH), 2) Include specialist

How to Get Fintepla (Fenfluramine) Covered by Aetna (CVS Health) in New York: Complete Guide to Prior Authorization and Appeals

Answer Box: Fastest Path to Fintepla Coverage Is Fintepla covered by Aetna (CVS Health) in New York? Yes, but requires prior authorization for seizures associated with Dravet syndrome or Lennox-Gastaut syndrome in patients ≥2 years old. Fastest approval path: (1) Enroll in the FINTEPLA REMS program with baseline echocardiogram, (2)

How to Get Cresemba (Isavuconazole) Covered by Aetna CVS Health in California: Prior Authorization Forms, Appeals, and Success Strategies

Answer Box: Getting Cresemba Approved by Aetna CVS Health in California Quick Path to Approval: Aetna CVS Health requires prior authorization for Cresemba (isavuconazole) in California. Your fastest route: (1) Confirm your plan type (HMO vs PPO affects appeal rights), (2) Submit PA with diagnosis codes B44.x (aspergillosis) or

Lowering Out-of-Pocket for Idelvion (albutrepenonacog alfa; rFIX-FP) with Aetna CVS Health in Illinois: Copay, Tiering & Assistance

Quick Answer: Idelvion is typically on Aetna's Tier 4 specialty formulary with prior authorization required. Illinois residents can reduce costs through CSL Behring's $12,000 copay assistance (commercial insurance), PAN Foundation grants, and formulary exceptions for step therapy. Start by calling Aetna member services to confirm

How to Get Carbaglu (Carglumic Acid) Covered by Aetna CVS Health in New Jersey: Complete Guide to Forms, Appeals, and Approval

Answer Box: Getting Carbaglu Covered by Aetna CVS Health in New Jersey Quick Path to Approval: Aetna CVS Health covers Carbaglu (carglumic acid) for NAGS deficiency and specific organic acidemias with prior authorization. You'll need genetic/enzyme testing confirming diagnosis, elevated ammonia labs, and metabolic specialist documentation. Submit

Do You Qualify for HyperHEP (hepatitis B immune globulin) Coverage by Aetna (CVS Health) in Pennsylvania? Decision Tree & Next Steps

Answer Box: Getting HyperHEP Covered by Aetna (CVS Health) in Pennsylvania Yes, HyperHEP (hepatitis B immune globulin) is covered by Aetna (CVS Health) in Pennsylvania with prior authorization. The fastest path: 1) Document exposure details and patient's anti-HBs status (<10 mIU/mL), 2) Submit PA through Availity