Topic

Aetna (CVS Health)

A collection of 1144 issues

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

Answer Box: Getting Defitelio Covered by Aetna CVS Health in New Jersey Defitelio requires prior authorization from Aetna CVS Health for hepatic veno-occlusive disease (VOD) with organ dysfunction following stem cell transplant. Your transplant team must submit clinical documentation proving VOD diagnosis using Baltimore or Cairo criteria, plus evidence of

Do You Qualify for Kanuma (Sebelipase Alfa) Coverage by Aetna (CVS Health) in Michigan? Decision Tree & Next Steps

Quick Answer: Kanuma (Sebelipase Alfa) Coverage Eligibility You likely qualify for Kanuma coverage by Aetna (CVS Health) in Michigan if you have: confirmed LAL-D diagnosis with both reduced enzyme activity (<10% normal) AND pathogenic LIPA gene variants, plus elevated liver enzymes (ALT ≥1.5x upper normal limit). First step:

Get Trikafta Covered by Aetna CVS Health in Florida: Complete Prior Authorization Guide with Forms and Appeals

Answer Box: Getting Trikafta Covered by Aetna CVS Health in Florida Quick Start: Trikafta requires prior authorization from Aetna CVS Health with CFTR genotype documentation. Submit requests via CoverMyMeds or fax to 855-799-2554 with genetic testing results, baseline liver function tests, and clinical notes. Standard approval takes 24 hours; appeals

How to Get Ruconest (C1 Esterase Inhibitor) Covered by Aetna CVS Health in Texas: Complete Guide with Forms and Appeal Process

Quick Answer: Getting Ruconest Covered by Aetna CVS Health in Texas To get Ruconest (C1 esterase inhibitor [recombinant]) covered by Aetna CVS Health in Texas, you'll need prior authorization requiring HAE diagnosis confirmation, prescriber specialty verification (immunologist/allergist), and documentation that you're 13+ years old. Submit

How to Get Takhzyro (lanadelumab-flyo) Covered by Aetna CVS Health in Virginia: Complete Guide to Forms, Appeals, and Approval

Quick Answer: Getting Takhzyro Covered by Aetna CVS Health in Virginia Eligibility: Aetna CVS Health requires prior authorization for Takhzyro (lanadelumab-flyo) with confirmed HAE Type 1 or 2 diagnosis, documented attack history (≥1 attack per 4 weeks), and specialist prescription. Fastest approval path: Submit complete PA packet with C1-INH lab

Myths vs. Facts: Getting Koselugo (Selumetinib) Covered by Aetna CVS Health in North Carolina - Complete Appeals Guide

Answer Box: Getting Koselugo Covered by Aetna CVS Health in North Carolina Eligibility: Pediatric patients ≥2 years with confirmed NF1 and symptomatic, inoperable plexiform neurofibromas. Fastest approval path: Submit complete prior authorization with baseline LVEF assessment, ophthalmologic evaluation, and MRI-confirmed diagnosis through CVS Specialty. First step today: Contact your pediatric

Work With Your Doctor to Get Lamzede (velmanase alfa-tycv) Approved by Aetna CVS Health in Georgia

Answer Box: Getting Lamzede Approved by Aetna CVS Health in Georgia Lamzede (velmanase alfa-tycv) requires prior authorization from Aetna CVS Health for alpha-mannosidosis treatment. Success depends on partnering with your doctor to submit comprehensive documentation including confirmed diagnosis, functional assessments, and medical necessity justification. In Georgia, you have 60 days

How to Get Cosentyx (secukinumab) Approved by Aetna CVS Health in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Cosentyx Approved by Aetna CVS Health in North Carolina Eligibility: Patients with moderate-to-severe plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, or hidradenitis suppurativa who meet step therapy requirements. Fastest Path: Complete Aetna's Cosentyx precertification form, document prior therapy failures, submit TB screening results, and submit via

How to Get Emgality (galcanezumab-gnlm) Covered by Aetna CVS Health in California: Complete Appeals Guide

Answer Box: Getting Emgality Covered by Aetna CVS Health in California Emgality (galcanezumab-gnlm) requires prior authorization through Aetna CVS Health and must be dispensed through CVS Specialty Pharmacy. You'll need documented failure of at least two standard migraine preventives. Start today by: (1) Having your doctor submit the

How to Get Ibrance (Palbociclib) Covered by Aetna CVS Health in Florida: Complete Authorization Guide and Appeals Process

Answer Box: Quick Path to Ibrance Coverage with Aetna CVS Health in Florida Aetna CVS Health requires prior authorization for Ibrance (palbociclib) in Florida. Your oncologist must submit documentation proving HR+/HER2- metastatic breast cancer with pathology reports, prior treatment history, and combination therapy details through CVS Specialty Pharmacy. Standard