Topic

Aetna (CVS Health)

A collection of 133 issues

How to Get Synagis (Palivizumab) Covered by Aetna CVS Health in New York: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Synagis Covered by Aetna CVS Health in New York Aetna CVS Health requires prior authorization for Synagis (palivizumab) and only covers it when Beyfortus is contraindicated, not tolerated, or ineffective. Your child must meet strict high-risk criteria: premature infants <29 weeks and <12 months old,

Myths vs. Facts: Getting Evkeeza (evinacumab-dgnb) Covered by Aetna (CVS Health) in North Carolina

Answer Box: Fast Track to Evkeeza Coverage Getting Evkeeza (evinacumab-dgnb) covered by Aetna (CVS Health) in North Carolina requires prior authorization and documented failure of standard therapies. The fastest path: ensure your doctor submits comprehensive documentation of HoFH diagnosis, failed statin/ezetimibe/PCSK9 inhibitor trials, and current LDL-C levels via

How to Get Rapivab (Peramivir) Covered by Aetna CVS Health in Pennsylvania: Appeals Guide & Templates

Quick Answer: Getting Rapivab Covered by Aetna CVS Health in Pennsylvania Rapivab (peramivir) requires prior authorization from Aetna CVS Health and is covered on their 2024 Medicare formulary in Pennsylvania. If denied, you have strong appeal rights: complete Aetna's internal appeal within 180 days, then use Pennsylvania'

How to Get Duopa Covered by Aetna CVS Health in North Carolina: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Duopa Covered by Aetna CVS Health in North Carolina Duopa (carbidopa/levodopa enteral) requires prior authorization from Aetna CVS Health and typically involves step therapy requirements. To get coverage approved in North Carolina: 1. Document failed oral therapy - Your neurologist must show you've tried

How to Get Rezlidhia (olutasidenib) Covered by Aetna CVS Health in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Rezlidhia Coverage Getting Rezlidhia (olutasidenib) covered by Aetna CVS Health in Michigan requires prior authorization with documented IDH1 mutation, hematology/oncology specialist prescription, and evidence of prior therapy failures. Start by having your oncologist submit a PA request through Aetna's provider portal with

How to Get Soliris (Eculizumab) Covered by Aetna (CVS Health) in Florida: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Soliris Covered by Aetna (CVS Health) in Florida Step 1: Submit prior authorization through CVS Specialty Pharmacy with lab-confirmed diagnosis, meningococcal vaccination records, and REMS enrollment. Step 2: If denied, file internal appeal within 180 days using clinical documentation and medical necessity letter. Step 3: Request external

How to Get Photrexa (Riboflavin) Covered by Aetna CVS Health in Ohio: Complete Prior Authorization Guide

Answer Box: Getting Photrexa Covered by Aetna CVS Health in Ohio Aetna CVS Health covers epithelium-off corneal cross-linking with Photrexa for progressive keratoconus and ectasia. The fastest path to approval: 1) Verify your plan covers CPT code 0402T, 2) Submit prior authorization with documented keratoconus progression (serial topography, Kmax increases)

How to Get Kanuma (Sebelipase Alfa) Covered by Aetna (CVS Health) in Ohio: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Kanuma Covered by Aetna in Ohio Kanuma (sebelipase alfa) requires prior authorization from Aetna (CVS Health) for LAL-D patients. The fastest path: your doctor submits a prior authorization request through Aetna's Availity portal with LAL enzyme activity test results, genetic confirmation, and documented hepatic/lipid

Complete Guide: Getting Busulfex (Busulfan Injection) Covered by Aetna in New York - Prior Authorization, Appeals & Forms

Answer Box: Getting Busulfex Covered by Aetna in New York Busulfex (busulfan injection) requires prior authorization from Aetna for transplant conditioning in chronic myeloid leukemia. The fastest path to approval involves three key steps: (1) Confirm your transplant center is an Aetna Institute of Excellence facility, (2) Have your transplant

If Pemazyre (Pemigatinib) Isn't Approved by Aetna CVS Health in Ohio: Formulary Alternatives & Exception Paths

Answer Box: Fast Track to Pemazyre Coverage If Aetna CVS Health denies Pemazyre (pemigatinib) in Ohio, you have three main paths: formulary exception request (if non-formulary), prior authorization appeal (if denied for medical necessity), or trying alternative FGFR inhibitors first. Most denials stem from missing FGFR2 fusion test results or