Topic

Aetna (CVS Health)

A collection of 1128 issues

How to Get Galafold (Migalastat) Approved by Aetna CVS Health in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Galafold Approved by Aetna CVS Health in Michigan Aetna CVS Health requires prior authorization for Galafold (migalastat) in Michigan with 15-day standard or 72-hour expedited decisions. You'll need: confirmed Fabry disease diagnosis, documented amenable GLA variant, specialist prescription (nephrology/genetics/cardiology), and either ERT failure

Work With Your Doctor to Get Evkeeza (evinacumab-dgnb) Approved by Aetna (CVS Health) in Florida: Medical Necessity Letters, Appeals, and Provider Scripts

Answer Box: How to Get Evkeeza Covered by Aetna (CVS Health) in Florida Getting Evkeeza (evinacumab-dgnb) approved by Aetna (CVS Health) in Florida requires prior authorization with documented homozygous familial hypercholesterolemia (HoFH) and failure of maximally tolerated statin, ezetimibe, and PCSK9 inhibitor therapy. First step: Schedule an appointment with your

How to Get Myozyme (Alglucosidase Alfa) Covered by Aetna (CVS Health) in Michigan: Complete Authorization & Appeal Guide

Answer Box: Getting Myozyme Covered by Aetna (CVS Health) in Michigan Aetna (CVS Health) requires prior authorization for Myozyme (alglucosidase alfa) for Pompe disease. Success requires: (1) confirmed Pompe diagnosis via enzyme assay and genetic testing, (2) prescription from a metabolic/lysosomal storage disease specialist, and (3) proper documentation submission.

The Requirements Checklist to Get Synagis (Palivizumab) Covered by Aetna (CVS Health) in Florida

Answer Box: Getting Synagis Covered by Aetna (CVS Health) in Florida Synagis (palivizumab) requires prior authorization from Aetna (CVS Health) for high-risk infants meeting specific AAP criteria. The fastest path: (1) Have your pediatric specialist complete Aetna's Synagis PA form with detailed clinical documentation, (2) Submit via Aetna&

How to Get Pyrukynd (mitapivat) Covered by Aetna (CVS Health) in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Pyrukynd (mitapivat) Covered by Aetna (CVS Health) in North Carolina Pyrukynd (mitapivat) is non-formulary on Aetna plans and requires prior authorization with strict genetic and clinical criteria. You'll need confirmed pyruvate kinase deficiency (≥2 PKLR variants with ≥1 missense), hemoglobin ≤10 g/dL or significant

Getting Lamzede (Velmanase Alfa-tycv) Covered by Aetna CVS Health in Pennsylvania: ICD-10, HCPCS Codes, and Appeals Guide

Answer Box: Getting Lamzede Covered by Aetna CVS Health in Pennsylvania Lamzede (velmanase alfa-tycv) requires prior authorization from Aetna CVS Health in Pennsylvania. Submit through Availity/Novologix with confirmed alpha-mannosidosis diagnosis (ICD-10: E77.1), genetic or enzyme testing, and specialist letter. Bill using HCPCS J0217 (1 unit = 1 mg). If

Do You Qualify for Vyndaqel / Vyndamax (Tafamidis) Coverage by Aetna (CVS Health) in Michigan? Decision Tree & Next Steps

Answer Box: Quick Eligibility Check You likely qualify for Vyndaqel/Vyndamax coverage if you have: (1) confirmed ATTR-CM by PYP scan grade 2-3 or biopsy, (2) excluded AL amyloidosis with negative monoclonal studies, and (3) NYHA Class I-III symptoms. First step today: Have your cardiologist submit prior authorization through Aetna&

How to Get Revcovi (Elapegademase) Covered by Aetna CVS Health in Georgia: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Revcovi Covered in Georgia Fastest path to approval: Submit Aetna's specialty medication precertification form with confirmed ADA-SCID diagnosis, specialist letter, and genetic/enzyme testing results. If denied, file internal appeal within 180 days, then Georgia external review within 60 days. Start today: Call 1-866-752-7021 (Aetna

Myths vs. Facts: Getting Gamifant (Emapalumab-lzsg) Covered by Aetna CVS Health in Texas

Answer Box: Getting Gamifant Covered by Aetna CVS Health in Texas Eligibility: Aetna CVS Health covers Gamifant (emapalumab-lzsg) for primary HLH patients with refractory, recurrent, or progressive disease after conventional therapy failure. Fastest approval path: Submit prior authorization with complete HLH-2004 criteria documentation, genetic testing results, and detailed conventional therapy

Work With Your Doctor to Get Crysvita (burosumab) Covered by Aetna (CVS Health) in Pennsylvania: Complete Provider Collaboration Guide

Quick Answer: Your Path to Crysvita Coverage Getting Crysvita (burosumab) covered by Aetna (CVS Health) in Pennsylvania requires close collaboration with your endocrinologist or nephrologist to document X-linked hypophosphatemia (XLH) diagnosis and failed conventional therapy. The fastest path: (1) gather complete diagnostic records (genetic testing, low serum phosphorus, radiographic evidence)