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Aetna (CVS Health)

A collection of 1136 issues

Renewing Opdivo (Nivolumab) Coverage with Aetna (CVS Health) in Virginia: Complete Documentation Guide and Appeal Timeline

Answer Box: Opdivo (Nivolumab) Renewal with Aetna (CVS Health) in Virginia Aetna (CVS Health) requires prior authorization renewal for Opdivo (nivolumab) every 6 months. Submit renewal requests at least 14 days before your current authorization expires via the Availity portal using Novologix. Required documentation includes recent imaging showing no disease

How to Get Carbaglu (Carglumic Acid) Covered by Aetna CVS Health in Washington: Complete PA Guide with Appeals Process

Answer Box: Getting Carbaglu (Carglumic Acid) Covered by Aetna CVS Health in Washington Fastest path to approval: Submit prior authorization with confirmed NAGS deficiency diagnosis (genetic/enzyme testing) plus baseline elevated ammonia levels. Aetna requires 12-month PA for all FDA-approved indications. If denied, file internal appeal within 180 days, then

How to Get Rapivab (Peramivir) Covered by Aetna (CVS Health) in Illinois: Appeal Scripts, Timeline & Forms

Quick Answer: Getting Rapivab (Peramivir) Covered by Aetna (CVS Health) in Illinois Fast track to approval: Rapivab (peramivir) is typically covered under Aetna's medical benefit for hospitalized patients, not as a pharmacy drug. For outpatient use, you'll need prior authorization showing you can't take

How to Get Ilaris (Canakinumab) Covered by Aetna CVS Health in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Ilaris (Canakinumab) Covered by Aetna CVS Health in California Yes, Aetna CVS Health covers Ilaris (canakinumab) in California with prior authorization for FDA-approved indications. For Still's disease and periodic fever syndromes, you'll need specialist documentation of diagnosis, failed conventional therapies, and active disease.

How to Get Revlimid (lenalidomide) Covered by Aetna (CVS Health) in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Aetna (CVS Health) to Cover Revlimid (lenalidomide) in Georgia Aetna (CVS Health) requires prior authorization for Revlimid (lenalidomide) in Georgia, typically approving FDA-labeled uses (multiple myeloma, MDS with del[5q], mantle cell lymphoma) when REMS compliance and clinical criteria are met. First step today: Have your oncologist

How to Get Kanuma (Sebelipase Alfa) Covered by Aetna CVS Health in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Kanuma Approved by Aetna CVS Health in Florida Kanuma (sebelipase alfa) requires prior authorization from Aetna CVS Health in Florida. To get approval: (1) Confirm LAL-D diagnosis with enzyme testing and genetic results, (2) Document ALT ≥1.5× upper limit normal on two measurements one week apart,

Work With Your Doctor to Get Epidiolex (Cannabidiol) Approved by Aetna (CVS Health) in North Carolina: Forms, Appeals, and State Protections

How to Get Epidiolex (Cannabidiol) Covered by Aetna (CVS Health) in North Carolina Quick Answer: Aetna (CVS Health) covers Epidiolex for Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex with prior authorization and often step therapy. Your neurologist must document failed trials of standard antiseizure medications and submit a medical

How to Get Trikafta Covered by Aetna CVS Health in Pennsylvania: Complete Prior Authorization and Appeals Guide 2025

Answer Box: Getting Trikafta Covered by Aetna CVS Health in Pennsylvania Trikafta requires prior authorization from Aetna CVS Health with specific documentation: CF diagnosis, CFTR genotype (F508del or responsive mutation), age ≥2 years, and specialist prescription. Submit via CVS Specialty at 1-800-237-2767 with required labs and clinical notes. Standard approval

Work With Your Doctor to Get StrataGraft Approved by Aetna CVS Health in North Carolina: Complete Provider Partnership Guide

Answer Box: Your Path to StrataGraft Coverage Getting StrataGraft approved by Aetna CVS Health in North Carolina requires strong provider partnership. Your burn specialist must document that you're an adult with deep partial-thickness thermal burns requiring surgery, and that autograft alone isn't optimal. First step today:

If Eloctate Isn't Approved by Aetna (CVS Health) in New Jersey: Formulary Alternatives & Exception Paths

Answer Box If Aetna (CVS Health) denies Eloctate in New Jersey, your fastest options are: 1) Try preferred factor VIII products like Adynovate or Jivi first (step therapy), 2) Submit a formulary exception with documented failure/intolerance of preferred agents, or 3) Switch temporarily while appealing. Submit PA requests through