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Aetna (CVS Health)

A collection of 1288 issues

Requirements Checklist to Get Qinlock (ripretinib) Covered by Aetna CVS Health in Virginia

Answer Box: Getting Qinlock (ripretinib) Covered by Aetna CVS Health in Virginia Eligibility: Qinlock requires prior authorization from Aetna CVS Health for fourth-line GIST treatment after documented failure of imatinib, sunitinib, and regorafenib. Fastest path: Submit complete documentation including pathology report, treatment history with outcomes, and medical necessity letter through
6 min read

How to Get Revcovi (Elapegademase) Covered by Aetna (CVS Health) in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Revcovi Coverage in Pennsylvania Aetna (CVS Health) requires prior authorization for Revcovi (elapegademase) in Pennsylvania. Your fastest path: 1) Confirm ADA-SCID diagnosis with enzyme/genetic testing, 2) Have your immunologist/hematologist submit PA through Aetna's provider portal with medical necessity letter citing FDA
6 min read

How Long Does It Take to Get Hetlioz LQ (tasimelteon) Approved by Aetna CVS Health in California? Complete Timeline Guide

Answer Box: Quick Timeline Overview Aetna CVS Health prior authorization for Hetlioz LQ (tasimelteon oral suspension) in California takes 15-30 business days for standard review, with expedited approval available within 72 hours for urgent cases. Submit via electronic prior authorization (ePA) through CVS Caremark portal for fastest processing—over 95%
5 min read

Getting Kalydeco (Ivacaftor) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Fastest Path to Kalydeco Approval in North Carolina Aetna CVS Health requires prior authorization for Kalydeco (ivacaftor) with CFTR genetic testing confirming FDA-approved mutations (like G551D), CF specialist prescription, and baseline labs. Submit via Availity portal with genetic test results, specialist notes, and pulmonary function tests. If denied,
6 min read

Work With Your Doctor to Get Spinraza (nusinersen) Approved by Aetna (CVS Health) in Virginia: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Spinraza Covered by Aetna (CVS Health) in Virginia Aetna (CVS Health) requires prior authorization for all Spinraza (nusinersen) prescriptions in Virginia. Your neurologist must submit genetic testing confirming 5q SMA, baseline motor function assessment (HINE-2, HFMSE, or CHOP-INTEND), and clinical documentation showing you're not on
7 min read

How to Get Tepezza (Teprotumumab) Approved by Aetna CVS Health in Georgia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Tepezza Covered by Aetna CVS Health in Georgia Aetna covers Tepezza (teprotumumab) for thyroid eye disease under medical benefit with prior authorization requiring moderate-to-severe TED, ophthalmologist prescription, and documented steroid failures. Submit PA via Aetna provider portal with Clinical Activity Score ≥4, recent thyroid labs, and treatment
6 min read