Topic

Aetna (CVS Health)

A collection of 1130 issues

How to Get Lumizyme (alglucosidase alfa) Covered by Aetna (CVS Health) in Georgia: Complete Authorization Guide

Quick Answer: Getting Lumizyme Covered by Aetna in Georgia Aetna requires prior authorization for Lumizyme (alglucosidase alfa) with confirmed Pompe disease diagnosis and specialist prescriber. Submit the Aetna Lumizyme Precertification Form with enzyme assay or genetic testing results. If denied, you have 60 days to request external review through the

How to Get Natpara (Parathyroid Hormone) Covered by Aetna CVS Health in Ohio: 2025 Discontinuation Guide

Answer Box: Natpara Coverage with Aetna CVS Health in Ohio Critical Update: Takeda permanently discontinued Natpara manufacturing in 2024. The U.S. Special Use Program ends December 31, 2025. For existing patients in Ohio with Aetna CVS Health coverage: 1. Verify current coverage through your CVS Caremark member portal or

Get Brineura (Cerliponase Alfa) Covered by Aetna (CVS Health) in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Brineura Covered by Aetna in North Carolina Fastest path to approval: Have a CLN2-specialized neurologist submit prior authorization through Aetna's provider portal with documented motor function scores ≥1 on the CLN2 Clinical Rating Scale, confirmed TPP1 deficiency, and an approved intraventricular administration site. Authorization typically

Aetna's Coverage Criteria for Elevidys in Florida: What Counts as "Medically Necessary"?

Answer Box: Getting Elevidys Covered by Aetna in Florida Aetna requires prior authorization for Elevidys (delandistrogene moxeparvovec-rokl) with strict medical necessity criteria: confirmed DMD diagnosis with pathogenic gene mutation (excluding exons 8-9 deletions), ambulatory status, age ≥4 years, acceptable anti-AAVrh74 antibody levels, and comprehensive hepatic monitoring plan. Submit PA through

Work With Your Doctor to Get Eloctate Approved by Aetna CVS Health in Ohio: Complete Partnership Guide

Answer Box: Getting Eloctate Approved by Aetna CVS Health in Ohio Getting Eloctate (efmoroctocog alfa) covered by Aetna CVS Health in Ohio requires prior authorization and typically involves step therapy requirements. The fastest path: (1) Have your hematologist submit a complete PA request via Availity Provider Portal with documented failure

How to Get Acthar Gel Covered by Aetna CVS Health in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Acthar Gel Approved by Aetna CVS Health in Washington Aetna CVS Health requires prior authorization for all Acthar Gel (repository corticotropin injection) uses in Washington. The fastest path to approval: (1) Submit a complete Statement of Medical Necessity documenting failed corticosteroid therapy, (2) Call Aetna Specialty Pharmacy

Aetna (CVS Health) Coverage Criteria for Raxone (idebenone) in Georgia: What Counts as "Medically Necessary"?

Answer Box: Getting Raxone (idebenone) Covered by Aetna (CVS Health) in Georgia Raxone is not on Aetna's 2024 formularies, requiring a non-formulary exception with prior authorization. For LHON patients in Georgia: (1) Submit PA request with genetic confirmation and clinical documentation, (2) If denied, file internal appeal within

Getting Ultomiris (Ravulizumab) Covered by Aetna CVS Health in California: Forms, Appeals, and Alternative Options

Answer Box: Fast Track to Ultomiris Coverage To get Ultomiris (ravulizumab) covered by Aetna CVS Health in California: Submit the Ultomiris Precertification Request form with complete clinical documentation showing FDA-approved indication, failed alternatives, and vaccination records. If denied, file internal appeal within 60 days, then request California Independent Medical Review

Renewing Zokinvy (lonafarnib) Approval with Aetna CVS Health in Virginia: Complete Guide to Prior Authorization Renewal, Appeals, and Bridge Options

Quick Answer: Renewing Your Zokinvy (lonafarnib) Approval Aetna CVS Health typically requires annual prior authorization renewal for Zokinvy (lonafarnib) with updated clinical documentation showing ongoing medical necessity and benefit. Submit your renewal request 30-45 days before your current PA expires to avoid treatment interruption. Required documents include: genetic testing confirmation,

The Requirements Checklist to Get Ferriprox (Deferiprone) Covered by Aetna (CVS Health) in Ohio: Complete Guide with Forms and Appeals

Answer Box: Getting Ferriprox (Deferiprone) Covered by Aetna (CVS Health) in Ohio Fastest path to approval: Submit prior authorization through Aetna's pharmacy benefit with documented transfusional iron overload (ferritin >1,000 mcg/L), step therapy failure/intolerance to deferasirox or deferoxamine, and weekly ANC monitoring plan. First