Topic

Aetna (CVS Health)

A collection of 1351 issues

How to Get Darzalex (Daratumumab) Covered by Aetna CVS Health in New Jersey: Complete PA Forms, Appeals Guide & Contact Directory

Answer Box: Getting Darzalex Covered by Aetna CVS Health in New Jersey Aetna CVS Health requires prior authorization for Darzalex (daratumumab) in New Jersey, submitted via Availity portal or CVS Caremark at 1-800-294-5979. Coverage typically requires documentation of FDA-approved multiple myeloma indications, prior therapy failures, and prescriber attestation. If denied,
6 min read

Coding That Helps Get Zokinvy (Lonafarnib) Approved in Illinois with Aetna (CVS Health): ICD-10, HCPCS/J-Code, NDC

Answer Box Zokinvy (lonafarnib) requires prior authorization from Aetna (CVS Health) using ICD-10 code E34.8 (progeria), HCPCS J8499, and specific NDCs (60923-0544-53, 73079-0050-30). Submit genetic confirmation, BSA calculations, and specialist oversight through CVS Specialty Pharmacy. Illinois residents have 4 months to file external appeals through the Illinois Department of
5 min read

How to Get Elfabrio (pegunigalsidase alfa-iwxj) Covered by Aetna (CVS Health) in California: Complete Forms, Appeals & Contact Guide

Answer Box: Getting Elfabrio Covered by Aetna (CVS Health) in California Aetna (CVS Health) requires prior authorization for Elfabrio (pegunigalsidase alfa-iwxj) with confirmed Fabry disease diagnosis, specialist prescriber, and weight-based dosing documentation. Submit through CVS Specialty enrollment forms or Aetna provider portal. If denied, file internal appeal within 180 days,
6 min read

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

Answer Box: Getting Photrexa Covered by Aetna CVS Health in New York Yes, Aetna CVS Health covers Photrexa (riboflavin ophthalmic solution) for progressive keratoconus with prior authorization. To get approved in New York: (1) Your cornea specialist submits prior authorization with serial topography showing progression, (2) Aetna typically decides within
6 min read

How to Get Krystexxa (Pegloticase) Covered by Aetna CVS Health in California: Complete Prior Authorization and Appeals Guide

Answer Box: Get Krystexxa Covered by Aetna CVS Health in California Krystexxa (pegloticase) requires prior authorization from Aetna CVS Health for chronic gout patients who've failed allopurinol AND febuxostat. Submit complete documentation including G6PD test results, prior therapy records, and rheumatologist notes via medical benefit (J2507). If denied,
6 min read