Topic

Aetna (CVS Health)

A collection of 1072 issues

Renewing Orfadin (nitisinone) Approval with Aetna (CVS Health) in New Jersey: Timeline, Documentation & Appeal Process

Answer Box: Key Steps for Orfadin Renewal Success Orfadin (nitisinone) is excluded from Aetna's 2025 specialty formulary, requiring a formulary exception for any coverage. Start renewal 60-90 days early with updated labs (succinylacetone, tyrosine levels, liver function tests), metabolic specialist notes documenting treatment response, and dietary compliance records.
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How to Get Besponsa (Inotuzumab Ozogamicin) Covered by Aetna CVS Health in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Besponsa Covered by Aetna CVS Health in Washington Aetna CVS Health requires prior authorization for Besponsa (inotuzumab ozogamicin) in Washington. Coverage is approved for CD22-positive B-cell precursor ALL (relapsed/refractory) with documented prior therapy failures. Fastest path: Your oncologist submits the Aetna Besponsa precertification form with CD22+
6 min read

How to Get Evkeeza (Evinacumab-dgnb) Covered by Aetna in Texas: Complete Prior Authorization Guide with Appeals Process

Answer Box: Getting Evkeeza Covered by Aetna in Texas Evkeeza (evinacumab-dgnb) requires prior authorization from Aetna for homozygous familial hypercholesterolemia (HoFH) in patients ≥5 years. Submit Aetna's precertification form with HoFH documentation (genetic testing or clinical criteria), prior therapy failures (statin + ezetimibe + PCSK9 inhibitor), and current LDL-C levels.
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Lowering Out-of-Pocket for Kalydeco (ivacaftor) with Aetna (CVS Health) in Michigan: Copay Cards, Appeals & Financial Assistance

Answer Box: Getting Kalydeco Covered in Michigan Aetna (CVS Health) covers Kalydeco (ivacaftor) as a specialty drug requiring prior authorization and CFTR genotype confirmation. Michigan patients can access up to $20,000 annual copay assistance through Vertex GPS (commercial insurance only), plus foundation grants. First step today: Have your CF
6 min read

How to Get Pomalyst (pomalidomide) Covered by Aetna (CVS Health) in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Pomalyst (pomalidomide) Covered by Aetna (CVS Health) in Washington Aetna (CVS Health) requires prior authorization for Pomalyst (pomalidomide) with documented failure of both lenalidomide and a proteasome inhibitor, plus PS-Pomalidomide REMS enrollment. Submit PA within 24-48 hours of REMS completion via Aetna's provider portal with
7 min read

How to Get Besponsa (Inotuzumab Ozogamicin) Covered by Aetna CVS Health in Florida: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Quick Path to Besponsa Coverage with Aetna CVS Health in Florida Besponsa (inotuzumab ozogamicin) requires prior authorization from Aetna CVS Health for all Florida plans. Your oncologist must submit documentation proving relapsed/refractory CD22-positive B-cell precursor ALL, prior therapy failures, and liver monitoring plans. Standard decisions take 72
6 min read

How to Get Procysbi (Cysteamine Bitartrate DR) Covered by Aetna CVS Health in New York: Complete Requirements Checklist

Answer Box: Getting Procysbi Covered by Aetna CVS Health in New York Procysbi requires prior authorization through CVS Caremark with documented nephropathic cystinosis diagnosis (ICD-10 E72.04), baseline WBC cystine levels, and typically a trial/failure of immediate-release cysteamine. Submit via CVS Specialty Pharmacy enrollment with complete clinical documentation. If
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How to Get Kesimpta (ofatumumab) Covered by Aetna (CVS Health) in North Carolina: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Kesimpta (ofatumumab) Covered by Aetna (CVS Health) in North Carolina Kesimpta (ofatumumab) requires prior authorization from Aetna (CVS Health) for relapsing multiple sclerosis. Submit via CVS Caremark PA portal with neurologist letter documenting relapsing MS diagnosis (ICD-10: G35), prior DMT failures, and HBV screening. Standard decisions take
6 min read