Topic

Aetna (CVS Health)

A collection of 1288 issues

How to Get Revlimid (Lenalidomide) Covered by Aetna CVS Health in Michigan: Complete Prior Authorization Guide

Answer Box: Quick Path to Revlimid Coverage with Aetna CVS Health in Michigan Revlimid (lenalidomide) requires prior authorization from Aetna CVS Health for multiple myeloma, MDS, and lymphoma indications. Your fastest path: ensure REMS program enrollment first, then submit PA via Aetna's Availity portal with diagnosis confirmation and

How to Get Revlimid (lenalidomide) Approved by Aetna CVS Health in Florida: Complete Timeline and Appeals Guide

Answer Box: Getting Revlimid Covered by Aetna CVS Health in Florida Revlimid (lenalidomide) requires prior authorization from Aetna CVS Health, with decisions typically within 3-5 business days (or 72 hours if expedited). The fastest path: ensure REMS certification, submit complete PA documentation via Availity portal, and include diagnosis codes, prior

Get Myozyme (Alglucosidase Alfa) Covered by Aetna CVS Health in Washington: Complete PA Guide and Appeal Process

Answer Box: Your Fastest Path to Myozyme Coverage Myozyme (alglucosidase alfa) requires prior authorization from Aetna CVS Health, but is covered when medically necessary for confirmed Pompe disease. In Washington, submit your PA through CVS Specialty Pharmacy with GAA enzyme test results, genetic confirmation, and a specialist's medical

Myths vs. Facts: Getting Pemazyre (pemigatinib) Covered by Aetna (CVS Health) in North Carolina

Answer Box: Fast Track to Pemazyre (pemigatinib) Approval Getting Pemazyre (pemigatinib) covered by Aetna (CVS Health) in North Carolina requires prior authorization with FGFR testing documentation, prior therapy failure records, and medical necessity letters. Most denials stem from missing biomarker reports or inadequate step therapy documentation. First step: Gather FGFR2

How to Get Orladeyo (Berotralstat) Covered by Aetna CVS Health in Florida: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Orladeyo Covered by Aetna CVS Health in Florida Orladeyo (berotralstat) requires prior authorization from Aetna CVS Health for hereditary angioedema (HAE) prophylaxis. Your fastest path to approval: (1) Confirm HAE diagnosis with C1-INH lab results and clinical criteria, (2) Document any failed prior therapies, and (3) Have

How to Get Lumizyme (Alglucosidase Alfa) Covered by Aetna CVS Health in Ohio: Complete Authorization Guide

Answer Box: Getting Lumizyme Covered by Aetna CVS Health in Ohio Aetna requires prior authorization for Lumizyme (alglucosidase alfa) with confirmed Pompe disease diagnosis and specialist prescription. The fastest path to approval involves three key steps: (1) Submit the Aetna Lumizyme Precertification Form with enzyme/genetic testing results from your

How to Get Kesimpta (Ofatumumab) Covered by Aetna CVS Health in Pennsylvania: Complete Prior Authorization Guide

Answer Box: Getting Kesimpta Covered by Aetna CVS Health in Pennsylvania Kesimpta (ofatumumab) requires prior authorization from Aetna via CVS Caremark for relapsing multiple sclerosis treatment. Submit through the CVS Caremark portal or call 1-800-294-5979, including neurologist documentation of relapsing MS diagnosis, prior DMT failures, HBV screening, and recent MRI

How to Get Daybue (trofinetide) Covered by Aetna (CVS Health) in Washington: Complete PA Guide, Forms, and Appeal Process

Answer Box: Aetna (CVS Health) requires prior authorization for Daybue (trofinetide) with genetic confirmation of Rett syndrome (MECP2 mutation), specialist prescription, and age ≥2 years. Submit PA through Aetna provider portal with MECP2 test results, neurologist notes, and weight-based dosing calculation. If denied, Washington offers external review through Independent Review

How to Get Gilenya (Fingolimod) Covered by Aetna (CVS Health) in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Gilenya Covered by Aetna (CVS Health) in Michigan Gilenya (fingolimod) requires prior authorization from Aetna (CVS Health) for relapsing multiple sclerosis. Your neurologist must submit a specialty medication precertification request with baseline EKG, ophthalmology exam, vaccination records, and documentation of prior therapy failures. Submit via the Availity

Getting Natpara (Parathyroid Hormone) Covered by Aetna CVS Health in Pennsylvania: 2026 Discontinuation Guide and Alternative Coverage

Answer Box: Natpara Coverage Status with Aetna CVS Health in Pennsylvania Natpara (parathyroid hormone) is no longer available as Takeda discontinued manufacturing in December 2024, with the U.S. Special Use Program ending December 31, 2025. Aetna CVS Health now automatically denies new Natpara prescriptions due to lack of commercial