Topic

Aetna (CVS Health)

A collection of 1081 issues

Do You Qualify for Alecensa (alectinib) Coverage by Aetna (CVS Health) in Georgia? Complete Decision Tree & Appeals Guide

Answer Box: Quick Eligibility Check You likely qualify for Alecensa (alectinib) coverage by Aetna (CVS Health) if you have ALK-positive NSCLC (either metastatic/recurrent disease or adjuvant therapy after complete tumor resection with tumor ≥4cm or node-positive). First step today: Call the number on your Aetna insurance card to confirm

A Realistic Arcalyst (rilonacept) Approval Scenario with Aetna (CVS Health) in California: From Request to Yes

Answer Box: Getting Arcalyst Approved by Aetna in California Yes, Arcalyst (rilonacept) can be covered by Aetna (CVS Health) in California. The fastest path: 1) Your cardiologist submits a complete prior authorization packet via Availity portal documenting recurrent pericarditis and failed NSAIDs/colchicine, 2) Aetna reviews within 15 business days,

How to Get Nourianz (Istradefylline) Covered by Aetna in Florida: Prior Authorization, Appeals & Alternatives Guide

Answer Box: Getting Nourianz Covered by Aetna in Florida Nourianz (istradefylline) requires prior authorization from Aetna and is non-formulary on most 2024-2025 plans. To get coverage in Florida: 1) Have your neurologist submit a PA request documenting concurrent levodopa therapy, OFF-episode diary showing ≥3 hours daily OFF time, and failure/

How to Get Rinvoq (upadacitinib) Covered by Aetna CVS Health in Texas: Complete Guide with Forms and Appeals

Answer Box: Quick Start Guide Getting Rinvoq (upadacitinib) covered by Aetna CVS Health in Texas requires prior authorization with documented TNF inhibitor failure for most conditions. Submit the Texas Standard Prior Authorization Form to fax 1-877-269-9916 or via Availity portal. Include clinical notes showing inadequate response to at least one

How to Get Hetlioz LQ (Tasimelteon Oral Suspension) Covered by Aetna CVS Health in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Hetlioz LQ Covered by Aetna CVS Health in Michigan Hetlioz LQ (tasimelteon oral suspension) requires prior authorization from Aetna CVS Health for pediatric patients (3-15 years) with Smith-Magenis syndrome. Submit electronically via Caremark.com/epa with genetic confirmation, weight-based dosing calculations, and specialist documentation. If denied, you

How to Renew Epidiolex (Cannabidiol) Approval with Aetna CVS Health in Illinois: 2025 Requirements and Timeline

Answer Box: Renewing Your Epidiolex Approval To renew Epidiolex (cannabidiol) with Aetna CVS Health in Illinois, submit your prior authorization renewal 30-60 days before expiration with updated clinical documentation showing ongoing seizure control and liver function monitoring. Most renewals require: confirmed epilepsy diagnosis (LGS, Dravet, or TSC), current weight-based dosing

Renewing Jaypirca (Pirtobrutinib) Approval with Aetna CVS Health in California: Complete Timeline & Documentation Guide

Answer Box: Renewing Jaypirca Coverage with Aetna CVS Health Aetna CVS Health requires annual prior authorization (PA) renewal for Jaypirca (pirtobrutinib) in California. Start the renewal process 10-14 days before your current PA expires to avoid treatment gaps. Submit renewal through your oncologist's office via the Aetna provider

How to Get Oxlumo (Lumasiran) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization Guide

Answer Box: Getting Oxlumo (Lumasiran) Approved by Aetna CVS Health in Virginia Aetna CVS Health requires prior authorization for Oxlumo (lumasiran) in Virginia with genetic confirmation of PH1, baseline urinary oxalate levels, and specialist prescriber. Submit the Aetna Oxlumo Precertification Request Form with AGXT testing and labs. Standard approval takes

How to Renew Ofev (nintedanib) with Aetna CVS Health in Texas: Documentation Requirements and Timeline

Answer Box: Renewing Ofev (nintedanib) with Aetna CVS Health in Texas Aetna CVS Health requires renewal documentation every 12 months for Ofev (nintedanib). Start preparation 60 days before expiration with updated pulmonary function tests, HRCT results, and clinical notes showing disease stabilization or slowed progression. Submit via Aetna's

Aetna's Coverage Criteria for Hemlibra (emicizumab-kxwh) in North Carolina: What Counts as "Medically Necessary"?

Answer Box: Getting Hemlibra Approved by Aetna in North Carolina Aetna covers Hemlibra (emicizumab-kxwh) for hemophilia A prophylaxis when prescribed by a hematologist with documented FVIII deficiency and inhibitor status. Your fastest path: (1) Have your hematologist submit prior authorization via Aetna's provider portal with weight-based dosing, bleeding