Topic

Aetna (CVS Health)

A collection of 1137 issues

Myths vs. Facts: Getting Oxbryta (Voxelotor) Covered by Aetna in Illinois - What Patients Need to Know

Answer Box: Oxbryta Coverage Reality in Illinois Critical Update: Oxbryta (voxelotor) was voluntarily withdrawn from the U.S. market by Pfizer in September 2024 due to safety concerns. Claims are now denied due to loss of FDA approval. Illinois patients with sickle cell disease should work with their healthcare providers

How to Get Naglazyme (galsulfase) Covered by Aetna (CVS Health) in Illinois: Prior Authorization Guide, Appeal Scripts & Timeline

Answer Box: Getting Naglazyme (galsulfase) Covered by Aetna (CVS Health) in Illinois Naglazyme requires prior authorization from Aetna CVS Health. Your fastest path to approval: (1) Have your metabolic specialist submit enzyme assay or genetic testing confirming MPS VI diagnosis, (2) Request a medical necessity letter addressing Aetna's

How to Get Upstaza (Eladocagene Exuparvovec) Covered by Aetna CVS Health in Virginia: Complete Coverage Guide

Answer Box: Getting Upstaza Covered by Aetna CVS Health in Virginia Fastest path to approval: Upstaza (eladocagene exuparvovec), now FDA-approved as Kebilidi in the US, requires prior authorization through Aetna's Gene-Based, Cellular, and Other Innovative Therapies (GCIT) network. First step: contact your neurologist to confirm AADC deficiency diagnosis

How to Get Ferriprox (Deferiprone) Covered by Aetna CVS Health in California: Prior Authorization Appeals Guide 2025

Answer Box: Getting Ferriprox Covered by Aetna CVS Health in California Fastest path to approval: Submit prior authorization with documented ferritin >1,000 mcg/L, ANC monitoring plan, and diagnosis of transfusional iron overload from thalassemia or sickle cell disease. If denied, file internal appeal within 60 days, then

Renewing Prolastin-C (Alpha1-Proteinase Inhibitor) Approval with Aetna CVS Health in Washington: Timeline, Documentation & Appeal Guide

Answer Box: Renewing Prolastin-C Coverage with Aetna CVS Health Start your renewal 90 days early. Aetna typically approves Prolastin-C for 3-6 months initially, then 12-month renewals. You'll need updated AAT levels, FEV1 results, and proof of clinical benefit. Submit 60 days before expiration through CVS Caremark or your

How Long Does It Take to Get Vanflyta (Quizartinib) Approved by Aetna (CVS Health) in New York? Complete Timeline & Appeals Guide

Answer Box: Getting Vanflyta Covered by Aetna (CVS Health) in New York Standard approval timeline: 30-45 days for prior authorization, with expedited review available in 72 hours for urgent cancer treatment. Aetna requires FLT3-ITD mutation testing, baseline EKG showing QTc ≤450ms, and AML diagnosis confirmation. If denied, New York residents

How to Get Uplizna (Inebilizumab) Covered by Aetna CVS Health in New Jersey: Complete Prior Authorization Guide

Answer Box: Getting Uplizna Covered in New Jersey For AQP4-positive NMOSD or IgG4-related disease patients: Aetna CVS Health requires prior authorization for all Uplizna prescriptions. Your neurologist must submit documentation showing AQP4-antibody positive status, previous treatment failures, and hepatitis B screening results. Standard decisions take 5-7 business days; expedited reviews

How to Get Elfabrio (pegunigalsidase alfa-iwxj) Covered by Aetna CVS Health in North Carolina: Requirements, Appeals & Timeline

Answer Box: Getting Elfabrio Covered by Aetna CVS Health in North Carolina Eligibility: Adults 18+ with confirmed Fabry disease via enzyme assay or genetic testing. Fastest path: Submit prior authorization with quantitative enzyme levels, clinical notes showing organ involvement, and medical necessity letter. First step: Have your provider submit PA

How to Get Helixate (rFVIII) Covered by Aetna CVS Health in New York: Complete Prior Authorization Guide

Answer Box: Getting Helixate Covered by Aetna CVS Health in New York Important Update: Helixate has been discontinued in the US. You'll need prior authorization for alternative rFVIII products like Kovaltry, Advate, or Jivi through Aetna CVS Health. Submit the Medical Exception/Prior Authorization form with hemophilia A

How to Get Entresto (Sacubitril/Valsartan) Covered by Aetna CVS Health in Virginia: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Entresto Covered by Aetna CVS Health in Virginia Entresto requires prior authorization through Aetna CVS Health before coverage. Submit your request via Availity portal or fax to 1-833-280-5224. Include recent echocardiogram showing LVEF ≤40%, documented ACE inhibitor/ARB trial failure, and heart failure diagnosis with NYHA Class