Topic

Aetna (CVS Health)

A collection of 1288 issues

How to Get Lumizyme (Alglucosidase Alfa) Covered by Aetna CVS Health in New Jersey: Complete PA Guide and Appeal Process

Answer Box: Getting Lumizyme Covered by Aetna CVS Health in New Jersey Aetna CVS Health requires prior authorization for Lumizyme (alglucosidase alfa) in New Jersey, with no state-specific variations. To get approval: (1) Submit Aetna's Lumizyme precertification form with enzyme/genetic test results confirming Pompe disease, (2) Ensure

If Entresto Isn't Approved by Aetna CVS Health in Florida: Formulary Alternatives & Exception Paths

Answer Box: Your Options When Entresto Isn't Covered If Aetna CVS Health denies Entresto (sacubitril/valsartan) in Florida, you have three paths: try covered heart failure alternatives (ACE inhibitors, ARBs), request a formulary exception with clinical documentation, or appeal the denial through Florida's external review process.

How to Get Daybue (Trofinetide) Covered by Aetna CVS Health in Florida: Complete Coding, Prior Authorization, and Appeals Guide

Answer Box: Getting Daybue Covered by Aetna CVS Health in Florida Eligibility: Aetna requires genetic confirmation of MECP2 mutation, age ≥2 years, and specialist consultation for 12-month initial authorization. Fastest path: Submit prior authorization with ICD-10 F84.2, genetic test results, and clinical manifestations documentation. First step today: Contact your

How Long Does It Take to Get Cabometyx (Cabozantinib) Approved by Aetna CVS Health in Pennsylvania? Complete Timeline Guide

Answer Box: Cabometyx (Cabozantinib) Approval Timeline for Aetna CVS Health in Pennsylvania Cabometyx requires a formulary exception from Aetna CVS Health (excluded from Advanced Control formulary), taking 30-45 days for standard review or 72 hours for expedited cases. Pennsylvania residents benefit from a state external review program with 53% success

Get Cabometyx (Cabozantinib) Covered by Aetna in Michigan: Complete PA Guide and Appeals Process

Answer Box: Getting Cabometyx Covered by Aetna in Michigan Cabometyx (cabozantinib) requires prior authorization from Aetna CVS Health for all FDA-approved cancer indications in Michigan. The fastest path to approval: (1) Submit complete PA documentation through your oncologist including prior therapy failures and recent imaging, (2) Use Aetna's

How to Get Alprolix Covered by Aetna CVS Health in Texas: Complete PA Guide with Appeals Process

Answer Box: Getting Alprolix Covered by Aetna CVS Health in Texas Alprolix is excluded from Aetna's 2024 formularies, requiring a coverage exception for hemophilia B patients in Texas. Submit a prescriber-initiated exception request with documented factor IX deficiency ≤2%, bleeding history, and failed alternatives. Aetna must respond within

How to Get Stelara (ustekinumab) Covered by Aetna (CVS Health) in California: Prior Authorization, Appeals, and Alternative Options

Quick Answer: Getting Stelara Covered by Aetna in California Aetna (CVS Health) requires prior authorization for Stelara (ustekinumab) with step therapy requirements varying by indication. In California, you have strong appeal rights through the Department of Managed Health Care (DMHC) if denied. First step: Call Aetna at 1-888-632-3862 to confirm

How to Get Tavalisse (Fostamatinib) Covered by Aetna CVS Health in Washington: Forms, Appeals & Contact Guide

Quick Answer: Getting Tavalisse Covered by Aetna CVS Health in Washington Aetna CVS Health requires prior authorization for Tavalisse (fostamatinib) in Washington, with standard criteria including prior failures of corticosteroids, IVIG, and TPO agonists. Submit PA requests via your provider portal or fax to CVS Specialty at 1-800-323-2445. If denied,

If Tavneos (Avacopan) Isn't Approved by Aetna in Georgia: Formulary Alternatives & Exception Strategies

Quick Answer: If Aetna denies Tavneos (avacopan) for ANCA-associated vasculitis in Georgia, first-line alternatives include rituximab with steroids or cyclophosphamide with steroids—both typically covered with prior authorization. Submit a formulary exception request via CVS Specialty (1-866-814-5506) with documentation showing why alternatives failed or caused intolerable side effects. If denied,

How to Get Entresto (sacubitril/valsartan) Covered by Aetna (CVS Health) in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Entresto Covered by Aetna (CVS Health) in North Carolina Aetna (CVS Health) requires prior authorization for Entresto (sacubitril/valsartan) in heart failure with reduced ejection fraction (LVEF ≤40%). Submit complete documentation through the Aetna provider portal or fax 1-859-425-3379 within 14 days for approval. If denied, appeal