Topic

Aetna (CVS Health)

A collection of 1130 issues

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
5 min read

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)
6 min read

How to Get Keytruda (pembrolizumab) Covered by Aetna (CVS Health) in Florida: Renewal Guide, Appeal Scripts, and Timeline

Quick Answer: Getting Keytruda (pembrolizumab) Covered by Aetna (CVS Health) in Florida Aetna (CVS Health) requires prior authorization for Keytruda in Florida, with specific forms for commercial vs. Medicare plans. For renewals, submit updated clinical evidence showing continued benefit 6-8 weeks before your current authorization expires. If denied, you have
5 min read

Coding That Helps Get Rebif (Interferon Beta-1a) Approved by Aetna CVS Health in North Carolina: ICD-10, HCPCS, and NDC Guide

Answer Box: Getting Rebif Approved in North Carolina Rebif (interferon beta-1a) requires prior authorization from Aetna CVS Health in North Carolina. The fastest approval path: (1) Use correct ICD-10 code G35.A for relapsing-remitting MS with documented disease activity, (2) Submit complete prior authorization through CVS Specialty with step therapy
6 min read

How to Get Strensiq (asfotase alfa) Covered by Aetna (CVS Health) in California: Prior Authorization, Appeals, and Coverage Strategies

Answer Box: Getting Strensiq (asfotase alfa) Covered by Aetna (CVS Health) in California Fastest path to approval: Submit Aetna's 2025 Strensiq Precertification Form (fax 1-888-267-3277) with genetic testing confirming ALPL mutation, lab results showing persistently low alkaline phosphatase, radiographic evidence of bone disease, and medical records documenting pediatric-onset
6 min read

Work With Your Doctor to Get Myozyme (Alglucosidase Alfa) Approved by Aetna (CVS Health) in Illinois: Complete Provider Collaboration Guide

Answer Box: Getting Myozyme Approved by Aetna (CVS Health) in Illinois Fastest path: Partner with your specialist to submit a complete prior authorization with confirmed Pompe diagnosis (enzyme + genetic testing), documented functional decline, and evidence of medical necessity. If denied, file an internal appeal within 180 days, then request Illinois
7 min read

How to Get Juxtapid (lomitapide) Covered by Aetna (CVS Health) in Ohio: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Juxtapid (lomitapide) Covered by Aetna (CVS Health) in Ohio Aetna (CVS Health) requires prior authorization for Juxtapid (lomitapide) with documented homozygous familial hypercholesterolemia (HoFH) diagnosis and evidence of failure or intolerance to preferred therapies. First step today: Gather genetic testing results or clinical HoFH documentation, baseline LDL-C
5 min read