Topic

Aetna (CVS Health)

A collection of 1097 issues

The Requirements Checklist to Get Pomalyst (Pomalidomide) Covered by Aetna (CVS Health) in North Carolina

Answer Box: Fast Track to Pomalyst Coverage in North Carolina Aetna (CVS Health) requires prior authorization for Pomalyst (pomalidomide) with documented failure of lenalidomide plus a proteasome inhibitor. Submit PA via Availity portal with REMS enrollment proof, treatment timeline, and oncology notes. If denied, file internal appeal within 180 days,

The Requirements Checklist to Get Zolgensma (onasemnogene abeparvovec) Covered by Aetna (CVS Health) in Michigan

Answer Box: Getting Zolgensma Covered by Aetna (CVS Health) in Michigan Aetna requires prior authorization for Zolgensma (onasemnogene abeparvovec) via CVS Specialty Pharmacy. Key requirements: age under 24 months, bi-allelic SMN1 mutations, anti-AAV9 antibody titer ≤1:50, and treatment at a certified gene therapy center. Submit the Zolgensma Medication Precertification

How to Get Vimizim (elosulfase alfa) Covered by Aetna (CVS Health) in California: Complete Prior Authorization and Appeals Guide

Getting Vimizim (elosulfase alfa) covered by Aetna (CVS Health) in California requires prior authorization with confirmed MPS IVA diagnosis, specialist prescription, and baseline functional assessments. Submit documentation via Aetna's provider portal or call 1-888-632-3862 for PA forms. If denied, file an internal appeal within 180 days, then request

How to Get Hemgenix (etranacogene dezaparvovec) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Hemgenix Covered by Aetna CVS Health in Virginia Hemgenix (etranacogene dezaparvovec) requires prior authorization from Aetna CVS Health. Adults with severe hemophilia B (≤2% Factor IX) on prophylaxis or with serious bleeding history can qualify. Submit complete documentation including Factor IX levels, inhibitor tests, bleeding history, and

Get Voydeya (Danicopan) Covered by Aetna CVS Health in Florida: Complete Prior Authorization Guide

Answer Box: Getting Voydeya (danicopan) covered by Aetna CVS Health in Florida requires prior authorization proving you have PNH with extravascular hemolysis despite C5 inhibitor therapy. Fastest path: Have your hematologist submit PA via CVS Caremark's electronic portal with flow cytometry results, current C5 inhibitor details, and labs

How to Renew Bavencio (Avelumab) Coverage with Aetna CVS Health in California: 2025 Requirements & Timeline

Quick Answer: Renewing Your Bavencio Coverage To renew Bavencio (avelumab) with Aetna CVS Health in California, submit your continuation request at least 14 days before your next infusion using form GR-69328. You'll need recent imaging showing no disease progression, oncology notes confirming tolerability, and documentation of continuous months

How to Get Opfolda (miglustat) Covered by Aetna (CVS Health) in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Opfolda (miglustat) Covered by Aetna (CVS Health) in Ohio Aetna (CVS Health) requires prior authorization for Opfolda (miglustat) and will only approve it in combination with Pombiliti for adults with late-onset Pompe disease weighing ≥40 kg who are not improving on current enzyme replacement therapy. The fastest

How to Get Exondys 51 (eteplirsen) Covered by Aetna (CVS Health) in Washington: Appeals, Timelines & Templates

Answer Box: Your Fastest Path to Approval Getting Exondys 51 (eteplirsen) covered by Aetna (CVS Health) in Washington requires genetic testing proving exon 51-amenable DMD mutation, specialist prescriber, and functional documentation. Submit prior authorization with complete genetic report, 6-minute walk test results, and neuromuscular specialist letter. If denied, Washington law

Get Strensiq (Asfotase Alfa) Approved by Aetna (CVS Health) in Virginia: Complete Prior Authorization & Appeals Guide

Answer Box: Quick Start for Virginia Patients Strensiq (asfotase alfa) requires prior authorization from Aetna (CVS Health) in Virginia. To get approved, you need documented pediatric-onset hypophosphatasia with genetic/biochemical confirmation, radiographic evidence, and specialist prescription. Start today: Have your doctor complete Aetna's current Strensiq precertification form and

Getting Blenrep (Belantamab Mafodotin) Covered by Aetna CVS Health in Florida: Complete Prior Authorization and Appeal Guide

Answer Box: How to Get Blenrep Covered by Aetna CVS Health in Florida Aetna CVS Health requires prior authorization for Blenrep (belantamab mafodotin) with criteria including ≥4 prior therapy failures, documented disease progression, and REMS enrollment for ocular monitoring. Submit PA via Aetna provider portal with complete treatment history. If