Topic

Aetna (CVS Health)

A collection of 1124 issues

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

Work With Your Doctor to Get Vyondys 53 (Golodirsen) Approved by Aetna CVS Health in Georgia

Quick Answer: Getting Vyondys 53 Covered by Aetna CVS Health in Georgia To get Vyondys 53 (golodirsen) approved by Aetna CVS Health in Georgia, you'll need: (1) genetic testing confirming DMD with exon 53-amenable mutation, (2) specialist documentation of medical necessity, and (3) baseline functional assessments. Submit through

How to Get Zanzalintinib (XL092) Covered by Aetna CVS Health in Washington: Clinical Trial Access, Appeals & Timelines

Answer Box: Getting Zanzalintinib (XL092) Covered by Aetna CVS Health in Washington Zanzalintinib (XL092) is an investigational drug not FDA-approved, so standard Aetna CVS Health coverage is typically denied. The fastest path is through clinical trials (drug provided free by Exelixis) or compassionate use programs where Aetna may cover routine

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

Answer Box: Getting Givlaari (givosiran) covered by Aetna (CVS Health) in North Carolina requires prior authorization with specific documentation: elevated ALA/PBG levels during attacks, attack history requiring hospitalization or hemin, and specialist prescriber. Submit via CVS Caremark Specialty or Availity portal. If denied, North Carolina's Smart NC