Topic

Aetna (CVS Health)

A collection of 1142 issues

How to Get Xywav (Ca/Mg/K/Na oxybates) Covered by Aetna CVS Health in Michigan: Complete Guide to Prior Authorization, Appeals, and External Review

Quick Answer: Getting Xywav Covered by Aetna CVS Health in Michigan Xywav (calcium/magnesium/potassium/sodium oxybates) requires prior authorization from Aetna CVS Health before dispensing. You'll need REMS enrollment, documentation of narcolepsy or idiopathic hypersomnia diagnosis, and proof of step therapy completion (modafinil/armodafinil trials). Standard decisions

Myths vs. Facts: Getting Ocrevus (ocrelizumab) Covered by Aetna (CVS Health) in Florida

Answer Box: Getting Ocrevus Covered by Aetna in Florida Eligibility: Aetna covers Ocrevus for relapsing MS and primary progressive MS when prescribed by or in consultation with a neurologist. Fastest path: Submit complete prior authorization at least 2 weeks before treatment with MS diagnosis confirmation, prior therapy documentation, and hepatitis

How to Get Defitelio (Defibrotide) Covered by Aetna CVS Health in Florida: Complete Prior Authorization and Appeals Guide

Quick Start: Getting Defitelio (Defibrotide) Approved by Aetna CVS Health in Florida Defitelio requires prior authorization from Aetna CVS Health for hepatic veno-occlusive disease (VOD) treatment following hematopoietic stem cell transplant. Your transplant team must document VOD using Baltimore or Cairo criteria plus organ dysfunction. Submit through Aetna's

Work With Your Doctor to Get Uptravi (selexipag) Approved by Aetna (CVS Health) in New Jersey: Complete PA Guide

Quick Answer: Getting Uptravi (selexipag) Covered by Aetna (CVS Health) in New Jersey You're eligible for coverage if you have WHO Group I pulmonary arterial hypertension with documented functional class II-IV symptoms. The fastest path to approval requires your doctor to submit a prior authorization request through Aetna&

How to Get Xenpozyme (olipudase alfa-rpcp) Covered by Aetna CVS Health in Washington: Complete Timeline and Appeals Guide

Answer Box: Getting Xenpozyme Covered by Aetna CVS Health in Washington Timeline: 5-14 business days for standard prior authorization, 72 hours for expedited review. Requirements: Confirmed ASMD diagnosis with genetic testing (SMPD1 mutations) and enzyme activity <10% of normal, prescribed by metabolic specialist. First step: Have your doctor submit

How to Get Opsumit (Macitentan) Covered by Aetna in Georgia: Prior Authorization Guide & Appeal Scripts

Answer Box: Quick Path to Opsumit Coverage in Georgia To get Opsumit (macitentan) covered by Aetna in Georgia: Submit prior authorization with PAH specialist documentation, pregnancy testing compliance (for females), and ICD-10 codes I27.0 or I27.21. Use HCPCS J3490 with NDC 66215-501-15/30. If denied, file internal appeal

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

Quick Answer: Getting Entresto Covered by Aetna CVS Health in Texas Aetna CVS Health requires prior authorization for Entresto (sacubitril/valsartan), with decisions made within 72 hours for non-urgent requests. If denied, you have 180 days to file an internal appeal through your member portal or by calling the number

How to Get Amvuttra (Vutrisiran) Covered by Aetna CVS Health in New York: Complete PA Guide with Appeals Process

Answer Box: Getting Amvuttra (Vutrisiran) Covered by Aetna CVS Health in New York Fastest path to approval: Submit Aetna's Amvuttra precertification form with genetic testing (for hATTR-PN) or heart failure documentation (for ATTR-CM), plus evidence of contraindications to preferred alternatives like Onpattro or tafamidis. First step today: Verify

How to Get Somatuline Depot (Lanreotide) Covered by Aetna CVS Health in Florida: Complete Prior Authorization Guide

Answer Box: Getting Somatuline Depot Covered by Aetna CVS Health in Florida Fastest path to approval: Submit Aetna's Somatuline Depot Precertification Request form (GR-69561) with complete clinical documentation showing medical necessity for acromegaly, GEP-NETs, or carcinoid syndrome. Use the Availity provider portal for fastest processing (72-hour decisions vs.

Do You Qualify for Vimizim (Elosulfase Alfa) Coverage by Aetna (CVS Health) in Virginia? Decision Tree & Next Steps

Quick Answer: Your Path to Vimizim Coverage Likely eligible if: You have confirmed MPS IVA with documented GALNS enzyme deficiency or genetic testing, plus baseline functional assessments. Fastest path: Submit prior authorization through Availity portal at least 2 weeks before treatment start. First step today: Contact your metabolic specialist to