Topic

Aetna (CVS Health)

A collection of 1287 issues

How Long Does It Take to Get Crysvita (burosumab) Approved by Aetna CVS Health in California? Complete Timeline Guide

Quick Answer: Crysvita Approval Timeline with Aetna CVS Health in California Standard approval takes 30-45 days through CVS Specialty Pharmacy's prior authorization process. Expedited review (72 hours) is available if delays would jeopardize your health. California residents have strong appeal rights through the DMHC Independent Medical Review process,

How to Get Brineura (Cerliponase Alfa) Covered by Aetna (CVS Health) in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Brineura Covered by Aetna (CVS Health) in Texas Aetna requires prior authorization for Brineura (cerliponase alfa) in Texas with strict clinical criteria. You'll need confirmed CLN2 disease diagnosis, CLN2 Clinical Rating Scale scores ≥1 in motor and language domains, prescription by a pediatric neurologist or

How to Get Onpattro (Patisiran) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Onpattro (Patisiran) Covered by Aetna CVS Health in Virginia Aetna CVS Health covers Onpattro (patisiran) as a preferred specialty medication but requires prior authorization. To get approved: (1) Have your neurologist confirm hATTR polyneuropathy with genetic testing and document mNIS+7/6MWT scores, (2) Submit PA through

How to Get Tepezza (Teprotumumab) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Aetna CVS Health covers Tepezza for moderate-to-severe thyroid eye disease in Virginia with mandatory prior authorization requiring ophthalmologist evaluation, Clinical Activity Score ≥4, and documented steroid failure. Submit PA through CVS Specialty Pharmacy coordination. If denied, Virginia's Bureau of Insurance offers external review within 120 days

Myths vs. Facts: Getting Tysabri (Natalizumab) Covered by Aetna (CVS Health) in Virginia

Answer Box: Getting Tysabri Covered by Aetna (CVS Health) in Virginia Myth: If your doctor prescribes Tysabri, Aetna automatically covers it. Fact: Aetna requires prior authorization with TOUCH REMS enrollment, JCV antibody testing, baseline MRI, and documented step therapy failures for Crohn's disease. The fastest path to approval

How to Get Xospata (Gilteritinib) Covered by Aetna CVS Health in New York: Complete Appeals Guide

Quick Answer: Getting Xospata (Gilteritinib) Covered by Aetna CVS Health in New York Xospata (gilteritinib) is covered on Aetna formularies as a specialty oncology drug requiring prior authorization, FLT3 mutation testing, and specialty pharmacy dispensing. Your fastest path to approval: 1) Confirm your Aetna plan covers Xospata via the member

How to Get Taltz (Ixekizumab) Covered by Aetna CVS Health in New Jersey: Complete Prior Authorization and Appeals Guide

Aetna CVS Health requires prior authorization (PA) for Taltz (ixekizumab) in New Jersey, including step therapy with TNF inhibitor failure documentation, TB screening within 6 months, and specialist prescription. Submit the Taltz precertification form via fax (1-844-268-7263) or provider portal. If denied, you have 180 days for internal appeals, then

How to Get Cystadane (Betaine Anhydrous) Covered by Aetna CVS Health in New Jersey: Complete Prior Authorization Guide with Appeal Templates

Answer Box: Getting Cystadane Covered by Aetna CVS Health in New Jersey Cystadane (betaine anhydrous) requires prior authorization from Aetna CVS Health in New Jersey for homocystinuria treatment. Your fastest path to approval: (1) Confirm genetic diagnosis of CBS, MTHFR, or cobalamin deficiency with ICD-10 code E72.11, (2) Document

How Long Does It Take to Get Krystexxa (Pegloticase) Approved by Aetna (CVS Health) in Washington? Complete Timeline & Appeal Guide

Answer Box: Getting Krystexxa Approved by Aetna (CVS Health) in Washington Timeline: Standard prior authorization takes 24-72 hours with complete documentation; expedited reviews for urgent cases complete within 24 hours. Requirements: Age 18+, documented failure of conventional gout therapy (allopurinol/febuxostat), serum uric acid ≤6 mg/dL response, G6PD testing,

How to Get Lumizyme (Alglucosidase Alfa) Covered by Aetna CVS Health in New Jersey: Complete PA Guide and Appeal Process

Answer Box: Getting Lumizyme Covered by Aetna CVS Health in New Jersey Aetna CVS Health requires prior authorization for Lumizyme (alglucosidase alfa) in New Jersey, with no state-specific variations. To get approval: (1) Submit Aetna's Lumizyme precertification form with enzyme/genetic test results confirming Pompe disease, (2) Ensure