Topic

Aetna (CVS Health)

A collection of 133 issues

How to Renew Hetlioz (Tasimelteon) Coverage with Aetna CVS Health in North Carolina: Timeline, Documentation & Appeal Options

Answer Box: Renewing Hetlioz Coverage with Aetna CVS Health in North Carolina Hetlioz (tasimelteon) renewals with Aetna CVS Health typically require annual reapproval with updated clinical documentation. Start the renewal process 30 days before your current authorization expires to avoid treatment gaps. You'll need updated sleep specialist notes,

How to Get Gamifant (Emapalumab) Covered by Aetna in Ohio: Prior Authorization, Appeals & Step Therapy Guide

Answer Box: Getting Gamifant Covered by Aetna in Ohio Aetna covers Gamifant (emapalumab) for primary hemophagocytic lymphohistiocytosis (HLH) in Ohio when strict criteria are met. The fastest path to approval requires: (1) documenting primary HLH diagnosis using HLH-2004 criteria or genetic testing, (2) proving failure/intolerance to conventional therapy (etoposide

How to Get Isturisa (Osilodrostat) Covered by Aetna CVS Health in Washington: Complete Guide with Forms and Appeals

Quick Answer: Getting Isturisa (Osilodrostat) Covered by Aetna CVS Health in Washington Aetna CVS Health requires prior authorization for Isturisa (osilodrostat) in Washington. The fastest path to approval: (1) Verify your endocrinologist has documented Cushing's disease with failed/contraindicated surgery, (2) Complete Aetna's specialty medication prior

Work With Your Doctor to Get Onivyde (Irinotecan Liposome) Approved by Aetna CVS Health in Michigan

Quick Answer: Getting Aetna CVS Health to Cover Onivyde in Michigan Aetna (CVS Health) requires prior authorization for Onivyde (irinotecan liposome), but approval is achievable with proper documentation. Your doctor must submit a request at least two weeks before treatment through the Availity provider portal with complete medical records, diagnosis

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

Answer Box: Getting Imbruvica (ibrutinib) Covered by Aetna (CVS Health) in North Carolina Eligibility: Aetna requires prior authorization for Imbruvica and typically mandates step therapy with acalabrutinib or zanubrutinib first. Fastest approval path: Submit comprehensive PA documentation showing medical necessity for your FDA-approved indication (CLL/SLL, Waldenström's, or

Renewing Lamzede (Velmanase Alfa-tycv) Approval with Aetna in Texas: Complete 2024 Guide to Reauthorization, Documentation, and Appeals

Answer Box: Renewing Lamzede with Aetna in Texas Lamzede (velmanase alfa-tycv) requires annual reauthorization with Aetna. Start the renewal process 60 days before your current authorization expires. You'll need updated clinical documentation showing continued benefit: improved or stable 6-minute walk test, pulmonary function (FVC), or reduced serum oligosaccharides.

Renewing Vigabatrin (Sabril) Approval with Aetna CVS Health in California: Timeline, Documents & What to Prepare

Answer Box: Vigabatrin Renewal with Aetna CVS Health in California Vigabatrin (Sabril) prior authorization renewal with Aetna CVS Health requires documentation of continued seizure response (≥50% reduction from baseline), ongoing REMS program compliance with vision monitoring every 3 months, and submission 30-60 days before current approval expires. Start by gathering

How to Get Qalsody (Tofersen) Covered by Aetna CVS Health in Ohio: Forms, Appeals, and State Protections

Answer Box: Getting Qalsody (Tofersen) Covered by Aetna CVS Health in Ohio Aetna CVS Health requires prior authorization for Qalsody (tofersen) in Ohio. The fastest path to approval: 1) Confirm SOD1 mutation with genetic testing, 2) Submit complete PA request via Availity portal or fax 1-855-734-9389 with clinical documentation, 3)

How to Get Skyrizi (risankizumab) Covered by Aetna CVS Health in Illinois: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Skyrizi (risankizumab) Covered To get Skyrizi covered by Aetna CVS Health in Illinois: Your doctor must submit a prior authorization showing you meet medical necessity criteria—typically moderate-to-severe disease and documented failure or intolerance to at least one TNF inhibitor (like Humira). The process takes 30-45 days

How to Renew Epidiolex (Cannabidiol) Coverage with Aetna CVS Health in Florida: 2024-2025 Timeline and Requirements

Answer Box: Epidiolex Renewal with Aetna CVS Health in Florida Aetna CVS Health requires annual prior authorization renewal for Epidiolex for patients with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex. Start your renewal 60 days before expiration to avoid gaps. You'll need documented clinical response (seizure reduction)