Topic

Aetna (CVS Health)

A collection of 1144 issues

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

Getting StrataGraft Covered by Aetna CVS Health in Ohio: Complete Prior Authorization Guide and Appeals Process

Answer Box: Quick Eligibility Check To get StrataGraft covered by Aetna CVS Health in Ohio, you must be 18+ with deep partial-thickness thermal burns requiring surgical intervention. Submit prior authorization through your burn center using HCPCS code J7353 (medical benefit, not pharmacy). Include clinical photos, wound measurements, and burn surgeon

How to Get Luxturna (Voretigene Neparvovec-rzyl) Covered by Aetna in Michigan: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Luxturna Covered by Aetna in Michigan Luxturna requires prior authorization from Aetna for biallelic RPE65 mutation-associated retinal dystrophy. You'll need confirmed genetic testing, treatment at an approved center (Kellogg Eye Center at University of Michigan), and retinal viability documentation. If denied, Michigan gives you 127

How to Get Opdivo (Nivolumab) Covered by Aetna in Ohio: Forms, Appeals & Provider Contacts

Answer Box: Getting Opdivo (Nivolumab) Covered by Aetna in Ohio Opdivo (nivolumab) requires prior authorization from Aetna in Ohio. Fastest path to approval: 1) Verify your specific Aetna plan covers Opdivo for your diagnosis, 2) Have your oncologist submit a prior authorization request with complete medical records and evidence of

Renewing Eylea and Lucentis Approval with Aetna CVS Health in Pennsylvania: Timeline, Documentation, and Appeal Options

Answer Box: Renewing Your Eylea or Lucentis Coverage To renew Eylea (aflibercept) or Lucentis (ranibizumab) approval with Aetna CVS Health in Pennsylvania, start the process 60-90 days before your current authorization expires. You'll need updated OCT imaging, visual acuity measurements, and documentation of treatment response. Submit renewal requests

How to Get Dojolvi (Triheptanoin) Covered by Aetna CVS Health in Illinois: Complete Appeals Guide and Required Documentation

Answer Box: Getting Dojolvi Covered by Aetna CVS Health in Illinois Aetna CVS Health requires prior authorization for Dojolvi (triheptanoin) as it's not on standard formularies. Success requires molecular confirmation of LC-FAOD, specialist prescription, and documented MCT oil discontinuation. First step today: Contact your metabolic specialist to gather

How to Get Givlaari (givosiran) Covered by Aetna (CVS Health) in Texas: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Givlaari (givosiran) Covered by Aetna (CVS Health) in Texas Givlaari requires prior authorization from Aetna (CVS Health) in Texas. You'll need documented acute hepatic porphyria with elevated ALA/PBG levels, evidence of ≥2 qualifying attacks in 6 months or hemin use, and specialist involvement. Submit

How to Get Rebif (Interferon Beta-1a) Covered by Aetna CVS Health in Ohio: Copay Assistance, Appeals, and Prior Authorization Guide

Answer Box: Getting Rebif Covered by Aetna CVS Health in Ohio Aetna requires prior authorization for Rebif (interferon beta-1a) through CVS Caremark. Your neurologist must submit clinical documentation showing relapsing MS diagnosis, prior treatment failures, and medical necessity. If denied, you have 180 days to file an internal appeal, then

How to Get Opdivo (Nivolumab) Covered by Aetna CVS Health in North Carolina: Complete Appeals Guide

Answer Box: Getting Opdivo (Nivolumab) Covered by Aetna CVS Health in North Carolina Fastest Path to Coverage: Aetna requires prior authorization for Opdivo across all cancer indications. Submit complete documentation through the Availity provider portal at least two weeks before treatment. If denied, you have 60 days for internal appeals,

Renewing Revlimid (Lenalidomide) Coverage with Aetna CVS Health in Illinois: Complete Approval Guide

Answer Box: Getting Revlimid Covered by Aetna CVS Health in Illinois Revlimid requires prior authorization from Aetna CVS Health. Your prescriber must be REMS-certified and submit complete documentation including diagnosis confirmation, prior treatment history, and current lab results. Standard approval takes up to 15 days; expedited review is available within