Topic

Aetna (CVS Health)

A collection of 1143 issues

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

How to Get Cerezyme (imiglucerase) Covered by Aetna in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Cerezyme Covered by Aetna in New Jersey Aetna covers Cerezyme (imiglucerase) for confirmed Gaucher disease Types 1-3 with prior authorization. You'll need enzyme deficiency test results or genetic testing, plus documentation that Elelyso was ineffective or contraindicated. If denied, you have 180 days for internal

How to Get Myozyme (Alglucosidase Alfa) Covered by Aetna CVS Health in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Myozyme Covered by Aetna CVS Health in New York Fastest Path to Approval: Submit prior authorization through CVS Specialty Pharmacy with confirmed Pompe disease diagnosis (GAA enzyme testing + genetic confirmation), specialist evaluation, and dosing at 20 mg/kg every 2 weeks per FDA label. If denied, file

How to Get Synagis (Palivizumab) Covered by Aetna in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Synagis Approved by Aetna in Washington Aetna requires prior authorization for Synagis (palivizumab) and prioritizes Beyfortus as first-line therapy. To get coverage in Washington: (1) Submit Aetna's Synagis precertification form with clinical documentation proving high-risk criteria, (2) demonstrate why Beyfortus is contraindicated or inappropriate, and

How to Get Arcalyst (rilonacept) Covered by Aetna in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Arcalyst Covered by Aetna in New Jersey Fastest path to approval: Submit prior authorization through Availity provider portal with complete documentation including specialist consultation, prior therapy failures, and elevated inflammatory markers. Standard decisions take 45 business days; expedited reviews complete within 72 hours for urgent cases. If

If Idelvion Isn't Approved by Aetna CVS Health in Ohio: Formulary Alternatives & Exception Paths

Answer Box: Your Path Forward When Idelvion Is Denied If Aetna (CVS Health) denies Idelvion (albutrepenonacog alfa; rFIX-FP) coverage in Ohio, you have alternatives. Aetna's 2024 formulary covers Alprolix and Rebinyn as preferred factor IX products. If these don't work medically, request a formulary exception with

How to Get Xyrem (Sodium Oxybate) Covered by Aetna (CVS Health) in California: Complete 2025 Guide

Quick Answer: Getting Xyrem Covered by Aetna (CVS Health) in California Yes, Aetna covers Xyrem with prior authorization. You'll need REMS enrollment first, then submit PA with sleep study results and documented stimulant/modafinil failures. Standard approval takes 15 business days. If denied, California's Independent Medical

How to Get Soliris (Eculizumab) Covered by Aetna CVS Health in Michigan: Complete Prior Authorization Guide

Answer Box: Getting Soliris Covered by Aetna CVS Health in Michigan Fastest path to approval: Submit prior authorization with diagnosis-specific lab values (flow cytometry for PNH, anti-AChR antibodies for myasthenia gravis), proof of meningococcal vaccination, and documentation of failed therapies. First step today: Call Aetna at (866) 752-7021 to initiate

How to Get Darzalex / Darzalex Faspro (daratumumab) Covered by Aetna in Michigan: Prior Authorization Guide and Appeals Process

Answer Box: Getting Darzalex / Darzalex Faspro Covered by Aetna in Michigan Aetna requires prior authorization for both Darzalex (IV) and Darzalex Faspro (subcutaneous) in Michigan. Submit your PA request to (866) 752-7021 or fax (888) 267-3277 with complete clinical documentation including diagnosis, prior therapy failures, and treatment plan. If denied,

If Tavneos (Avacopan) Isn't Approved by Aetna (CVS Health) in Virginia: Formulary Alternatives & Exception Paths

Answer Box: Your Path Forward If Aetna (CVS Health) denies Tavneos (avacopan) for ANCA-associated vasculitis in Virginia, you have two main options: try formulary alternatives with step therapy or request a medical exception. First step today: Contact your rheumatologist or nephrologist to discuss rituximab or cyclophosphamide as alternatives while simultaneously