Topic

Aetna (CVS Health)

A collection of 1138 issues

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

How to Get Trikafta Covered by Aetna CVS Health in Washington: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Trikafta Covered by Aetna CVS Health in Washington Trikafta requires prior authorization from Aetna CVS Health before coverage. The fastest path to approval: your CF specialist submits a PA request with CFTR genotype results, baseline liver function tests, and medical necessity documentation. If denied, request a peer-to-peer

Renewing Uplizna (Inebilizumab) Coverage with Aetna CVS Health in Texas: 2025 Timeline & Documentation Guide

Quick Answer: Uplizna Renewal with Aetna CVS Health in Texas Start your Uplizna (inebilizumab) renewal 60-90 days before your current authorization expires. You'll need an updated medical necessity letter from your neurologist, recent lab results (immunoglobulin levels, hepatitis B screening), and documentation of treatment response. Submit through Aetna&

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Aetna CVS Health in New York: Prior Authorization Guide and Appeals Process

Quick Answer: Getting Enhertu Covered by Aetna in New York Getting Enhertu (fam-trastuzumab deruxtecan-nxki) approved by Aetna CVS Health requires prior authorization for all plans. Call (866) 752-7021 or fax (888) 267-3277 to start. You'll need HER2 pathology reports, prior therapy documentation, and a medical necessity letter with

Get Jaypirca (Pirtobrutinib) Approved by Aetna CVS Health in Ohio: Complete Prior Authorization Guide

Answer Box: Getting Jaypirca Approved in Ohio Jaypirca (pirtobrutinib) requires prior authorization from Aetna CVS Health in Ohio. Your oncologist submits the PA through CVS Caremark at 1-800-294-5979 with complete documentation of prior BTK inhibitor failure (and BCL-2 inhibitor for CLL/SLL). Over 95% of properly documented requests are approved

Work With Your Doctor to Get Haegarda (C1-esterase inhibitor, SC) Approved by Aetna (CVS Health) in Pennsylvania: Complete Provider Collaboration Guide

Quick Answer: Getting Haegarda Approved by Aetna CVS Health in Pennsylvania Eligibility: Confirmed HAE diagnosis with C1-INH deficiency, age ≥6 years, prescribed by specialist (allergist/immunologist). Fastest path: Schedule specialist visit to document attack frequency, complete Aetna's precertification form with lab results, and submit medical necessity letter. First

Myths vs. Facts: Getting Hemgenix (Etranacogene Dezaparvovec) Covered by Aetna (CVS Health) in North Carolina

Answer Box: Getting Hemgenix Covered by Aetna (CVS Health) in North Carolina Eligibility: Adults 18+ with severe/moderately severe hemophilia B (≤2% Factor IX activity), 150+ exposure days of Factor IX prophylaxis, and no inhibitor history. Fastest path: Submit complete prior authorization through CVS Specialty with all lab work, bleeding

How to Get Zokinvy (lonafarnib) Covered by Aetna (CVS Health) in Pennsylvania: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Zokinvy Covered by Aetna in Pennsylvania Zokinvy (lonafarnib) requires prior authorization from Aetna (CVS Health) for HGPS and progeroid laminopathies. Key requirements: genetic testing confirming LMNA/ZMPSTE24 mutations, BSA ≥0.39 m², age ≥12 months, and specialist consultation. First step: Contact your geneticist or pediatric cardiologist to

How to Get Tecentriq (Atezolizumab) Covered by Aetna CVS Health in Illinois: Forms, Appeals, and Expert Tips

Quick Answer: Getting Tecentriq Covered by Aetna CVS Health in Illinois Tecentriq (atezolizumab) requires prior authorization from Aetna CVS Health. Your fastest path to approval: 1) Verify your plan covers specialty oncology drugs through CVS Specialty at 1-800-323-2445, 2) Submit complete biomarker testing (PD-L1, EGFR, ALK as applicable) with your

Getting Breyanzi (Lisocabtagene Maraleucel) Covered by Aetna CVS Health in Ohio: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Breyanzi Covered by Aetna CVS Health in Ohio Breyanzi (lisocabtagene maraleucel) requires mandatory prior authorization from Aetna CVS Health before coverage. To qualify, you need confirmed relapsed/refractory large B-cell lymphoma after ≥2 prior therapies, ECOG performance status 0-2, and treatment at a certified CAR-T center. First