Topic

Aetna (CVS Health)

A collection of 1071 issues

How to Get Tysabri (Natalizumab) Covered by Aetna CVS Health in Georgia: Complete Prior Authorization Guide

Answer Box: Getting Tysabri Covered by Aetna CVS Health in Georgia Tysabri (natalizumab) requires prior authorization on all Aetna CVS Health plans in Georgia, with mandatory TOUCH program enrollment before approval. The fastest path: (1) Complete TOUCH enrollment at touchprogram.com for all parties, (2) Submit PA with JCV antibody

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

Answer Box: Getting Kineret Covered by Aetna in Georgia Kineret (anakinra) requires prior authorization from Aetna (CVS Health) as a Tier 5 specialty drug. For rheumatoid arthritis, you must document failure of at least one conventional DMARD (like methotrexate) and one preferred biologic. Submit through CVS Specialty Pharmacy or Aetna&

How to Get Breyanzi (Lisocabtagene Maraleucel) Covered by Aetna CVS Health in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Breyanzi Approved by Aetna CVS Health in California Breyanzi (lisocabtagene maraleucel) requires mandatory prior authorization from Aetna CVS Health under their medical benefit, with standard decisions taking 30-45 days. Submit via Availity provider portal or fax to 1-877-269-9916 at least 2 weeks before treatment. If denied, California

How to Get Berinert (C1-Esterase Inhibitor) Covered by Aetna CVS Health in Florida: Complete PA Guide with Forms and Appeals

Answer Box: Fast Track to Berinert Coverage with Aetna CVS Health in Florida Aetna CVS Health requires prior authorization for Berinert (C1-esterase inhibitor) in Florida. Your fastest path: Have your HAE specialist submit a PA request via the Aetna provider portal with confirmed HAE diagnosis, documented Ruconest failure/contraindication, and

Get Skyrizi (Risankizumab) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Skyrizi Covered by Aetna CVS Health in Virginia Aetna CVS Health requires prior authorization for Skyrizi (risankizumab) with step therapy mandates, typically requiring documented TNF inhibitor failure. Submit PA requests via Availity portal at least 2 weeks in advance. If denied, Virginia's State Corporation Commission

How to Get Ibrance (Palbociclib) Covered by Aetna (CVS Health) in Washington: Prior Authorization, Appeals, and Formulary Alternatives Guide

Answer Box: Getting Ibrance (Palbociclib) Approved by Aetna (CVS Health) in Washington Ibrance (palbociclib) requires prior authorization from Aetna (CVS Health) for HR+/HER2- metastatic breast cancer. Submit PA via provider portal or fax with pathology confirming HR+/HER2- status, prior endocrine therapy documentation, and prescriber attestation. Standard decisions take

How to Get Trikafta Covered by Aetna CVS Health in Texas: Complete Prior Authorization and Appeals Guide 2025

Quick Answer: Getting Trikafta Approved by Aetna CVS Health in Texas Trikafta requires prior authorization through CVS Caremark specialty pharmacy with CFTR genetic testing, CF specialist prescription, and age ≥2 years. Submit PA via Aetna provider portal with mutation documentation (F508del or responsive variants), baseline labs, and medical necessity letter.

How to Get Soliris (Eculizumab) Covered by Aetna CVS Health in Georgia: Complete Prior Authorization Guide

Quick Answer: Getting Soliris Covered by Aetna CVS Health in Georgia Aetna CVS Health requires prior authorization for Soliris (eculizumab) with diagnosis-specific criteria, mandatory meningococcal vaccination ≥2 weeks before treatment, and CVS Specialty Pharmacy dispensing. Submit the Soliris Precertification Form (GR-68742) via Availity portal or fax 1-844-268-7263. If denied, Georgia

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

Answer Box: Getting Mavenclad Covered by Aetna CVS Health in Florida Aetna CVS Health requires prior authorization for Mavenclad (cladribine tablets) with documented failure of ≥2 prior disease-modifying therapies, lymphocyte count ≥800 cells/μL, and neurologist prescribing. Submit PA via Availity portal or fax 1-866-249-6155. Standard decisions take 72 hours;

How to Get Tavalisse (fostamatinib) Covered by Aetna CVS Health in New Jersey: Complete Appeals Guide

Answer Box: Fast Track to Tavalisse Coverage Aetna CVS Health requires prior authorization for Tavalisse (fostamatinib) in New Jersey, with initial approval typically granted for 12 weeks when medical necessity criteria are met. The fastest path: have your hematologist submit a complete PA request through Availity with documented failure of