Topic

Aetna (CVS Health)

A collection of 645 issues

How to Get Cystadane (Betaine Anhydrous) Covered by Aetna CVS Health in Michigan: Prior Authorization Guide with Appeal Scripts

Answer Box: Getting Cystadane Covered by Aetna CVS Health in Michigan Cystadane (betaine anhydrous) requires prior authorization from Aetna CVS Health in Michigan. Submit your PA request electronically through the Availity provider portal at least two weeks before the fill date. Include genetic/biochemical confirmation of homocystinuria, previous vitamin therapy

How to Get Dupixent (dupilumab) Covered by Aetna CVS Health in North Carolina: Appeals Guide and Templates

Answer Box: Getting Dupixent Covered by Aetna CVS Health in North Carolina Dupixent requires prior authorization from Aetna CVS Health with specific step therapy requirements. For atopic dermatitis, you must document failure of high-potency topical corticosteroids or calcineurin inhibitors within 180 days. For asthma, inadequate response to inhaled corticosteroids is

How to Get Venclexta (Venetoclax) Covered by Aetna CVS Health in Illinois: Complete PA Guide and Appeal Process

Answer Box: Getting Venclexta (Venetoclax) Covered by Aetna CVS Health in Illinois Venclexta (venetoclax) requires prior authorization with Aetna CVS Health for CLL, SLL, and AML in Illinois. The fastest path to approval involves submitting complete clinical documentation including diagnosis confirmation, tumor lysis syndrome (TLS) monitoring plan, and prior therapy

How to Get Lutathera Covered by Aetna CVS Health in Illinois: Complete Prior Authorization Guide

Answer Box: Lutathera (lutetium Lu-177 dotatate) is covered by Aetna CVS Health in Illinois under the medical benefit with mandatory prior authorization. You'll need: confirmed somatostatin receptor-positive neuroendocrine tumor, documented failure of octreotide/lanreotide, and SSTR imaging results. Submit precertification 2+ weeks before treatment through Aetna's

How to Get Venclexta (venetoclax) Covered by Aetna (CVS Health) in Washington: Complete PA Guide and Appeal Process

Answer Box: Getting Venclexta (venetoclax) Covered by Aetna (CVS Health) in Washington Venclexta requires prior authorization from Aetna (CVS Health) for all indications. The fastest path to approval: (1) Document prior therapy failures (BTK inhibitors for CLL, appropriate treatments for AML), (2) Submit complete PA with tumor lysis syndrome prevention

How to Get Spinraza (nusinersen) Covered by Aetna (CVS Health) in Texas: Complete Prior Authorization Guide with Appeal Scripts

Answer Box: Getting Spinraza Covered by Aetna in Texas Aetna (CVS Health) covers Spinraza (nusinersen) for spinal muscular atrophy but requires prior authorization with genetic confirmation, neurologist attestation, and baseline motor function scores. If denied, Texas patients have strong appeal rights with ~58% success rates when both internal appeals and

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

Answer Box: Getting Defitelio Covered by Aetna CVS Health in Ohio Defitelio (defibrotide) requires prior authorization from Aetna CVS Health for hepatic VOD/SOS with organ dysfunction post-HSCT. Your transplant team must submit comprehensive documentation including VOD/SOS diagnosis per Baltimore/Cairo criteria, evidence of renal or pulmonary dysfunction, and

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

Answer Box: Helixate (rFVIII) requires prior authorization from Aetna CVS Health in North Carolina. However, Helixate and Kogenate FS have been discontinued—you'll need to request coverage for alternatives like Advate, Kovaltry, or Jivi. Submit the Medical Exception/Prior Authorization form with complete hemophilia A documentation via Availity

How to Get Kineret (anakinra) Covered by Aetna CVS Health in California: Forms, Appeals, and State Protections

Quick Answer: Getting Kineret Covered by Aetna CVS Health in California Eligibility: Kineret (anakinra) requires prior authorization from Aetna CVS Health for rheumatoid arthritis and NOMID. Fastest path: Document failure/intolerance of at least one conventional DMARD (like methotrexate) and one biologic DMARD, then submit PA through CVS Specialty Pharmacy

How to Get Humate-P Covered by Aetna CVS Health in New Jersey: Complete Forms, Appeals & Portal Guide

Answer Box: Getting Humate-P Covered by Aetna CVS Health in New Jersey Humate-P requires prior authorization from Aetna CVS Health for hemophilia A and von Willebrand disease treatment. Fastest approval path: Submit PA request via Aetna provider portal with recent VWF/Factor VIII labs, diagnosis confirmation, and desmopressin trial documentation