Topic

Aetna (CVS Health)

A collection of 1137 issues

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

Renewing Increlex (mecasermin) Approval with Aetna CVS Health in New Jersey: Complete Timeline & Documentation Guide

Answer Box: Renewing Increlex (mecasermin) with Aetna CVS Health in New Jersey Increlex (mecasermin) approvals with Aetna typically last 12 months and require annual reauthorization. Start renewal 30-45 days before expiration with updated growth data showing at least 2 cm/year velocity, open epiphyses confirmation, and safety monitoring records. Submit

How to Get Gattex (Teduglutide) Covered by Aetna CVS Health in Georgia: Complete Appeals Guide with Forms and Timelines

Quick Answer: To get Gattex (teduglutide) covered by Aetna CVS Health in Georgia, you need documented short bowel syndrome with parenteral nutrition dependence, specialist involvement, and baseline colon screening. Submit prior authorization through CVS Specialty with detailed PN logs. If denied, file internal appeals within 180 days, then Georgia external

Work With Your Doctor to Get Abecma (idecabtagene vicleucel) Covered by Aetna (CVS Health) in North Carolina: Complete Appeals Guide

Answer Box: Getting Abecma Covered by Aetna in North Carolina Eligibility: Adults with relapsed/refractory multiple myeloma after ≥2 prior lines including an IMiD, proteasome inhibitor, and anti-CD38 antibody. Fastest path: Work with your oncologist at a certified CAR-T center to submit a comprehensive prior authorization with documented treatment failures

How to Get Lutathera (Lutetium Lu-177 Dotatate) Covered by Aetna CVS Health in Washington: Complete Prior Authorization Guide

Answer Box: Getting Lutathera Covered by Aetna CVS Health in Washington Lutathera (lutetium Lu-177 dotatate) requires prior authorization from Aetna CVS Health. The fastest path to approval: 1) Verify your plan's formulary status and PA requirements through the Aetna member portal, 2) Submit a complete PA request with

How to Get Tremfya (guselkumab) Covered by Aetna in Washington: Appeals Guide with State Protections

Answer Box: Getting Tremfya (guselkumab) Covered by Aetna in Washington Fastest path to approval: Submit Aetna's prior authorization form with specialist documentation of diagnosis severity, prior treatment failures, and medical necessity. If denied, use Washington's internal appeal (180 days) followed by independent review organization (IRO) process

How to Get Zolgensma (onasemnogene abeparvovec) Covered by Aetna (CVS Health) in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by Aetna in Pennsylvania Aetna covers Zolgensma (onasemnogene abeparvovec) for spinal muscular atrophy under strict prior authorization requiring: confirmed bi-allelic SMN1 mutations, age under 24 months, anti-AAV9 antibody titer ≤1:50, and treatment at an approved gene therapy center. If denied, you have 180 days

Denied Koselugo (Selumetinib) Coverage by Aetna CVS Health in New Jersey? Complete Appeal Guide with Forms and Templates

Answer Box: Getting Koselugo (Selumetinib) Covered by Aetna CVS Health in New Jersey Quick Path to Approval: Submit a complete prior authorization with NF1 diagnosis confirmation, imaging showing symptomatic plexiform neurofibromas, and documentation that surgery isn't feasible. If denied, file an internal appeal within 180 days, then use

How to Get Palynziq (pegvaliase-pqpz) Covered by Aetna CVS Health in Ohio: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Palynziq (pegvaliase-pqpz) covered by Aetna CVS Health in Ohio requires prior authorization with documented blood phenylalanine levels ≥600 µmol/L, evidence of sapropterin failure, and REMS enrollment. If denied, you have 180 days for internal appeal and 180 days for external review through Ohio Department of Insurance.

How to Get Fabrazyme (agalsidase beta) Covered by Aetna in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Fabrazyme (agalsidase beta) requires prior authorization from Aetna in Washington. Your fastest path: 1) Have your specialist complete Aetna's PA form with genetic testing results and organ involvement documentation, 2) Submit via provider portal or fax, and 3) If denied, file internal appeal within 60-180 days,