Topic

Aetna (CVS Health)

A collection of 1144 issues

How to Get Amondys 45 (Casimersen) Covered by Aetna CVS Health in New York: Complete Guide with Forms, Timelines, and Appeal Strategies

Answer Box: Fast Track to Amondys 45 Coverage Aetna CVS Health requires prior authorization for Amondys 45 (casimersen) in New York. The fastest path: (1) Confirm genetic testing shows exon 45-skippable DMD mutation, (2) Have your neuromuscular specialist complete Aetna's precertification form, and (3) Submit via provider portal

How to Get Cimzia (Certolizumab Pegol) Covered by Aetna (CVS Health) in North Carolina: Complete Appeals Guide and Timeline

Answer Box: Getting Cimzia Covered by Aetna in North Carolina Eligibility: Cimzia requires prior authorization from Aetna (CVS Health) for all patients. You must have documented failure or intolerance to preferred alternatives and complete TB/hepatitis B screening. Fastest path: Submit complete prior authorization with medical necessity letter, screening results,

How to Get Turalio (pexidartinib) Covered by Aetna (CVS Health) in Georgia: Complete Forms, Appeals, and Approval Guide

Answer Box: Getting Turalio Covered by Aetna in Georgia Turalio (pexidartinib) requires prior authorization from Aetna (CVS Health) in Georgia. The fastest path: (1) Complete REMS program enrollment first, (2) Submit PA request through CVS Specialty at 1-800-237-2767 with TGCT diagnosis, surgical consultation, and baseline liver tests, (3) If denied,

How to Get Rebif (Interferon Beta-1a) Covered by Aetna (CVS Health) in Georgia: Complete Appeals Guide with Forms and State Resources

Answer Box: Get Rebif (Interferon Beta-1a) Covered by Aetna (CVS Health) in Georgia Rebif requires prior authorization from Aetna (CVS Health) with step therapy requirements in most plans. Fastest path to approval: Submit PA request with MS diagnosis, MRI evidence of activity, and documentation of preferred DMT failures/intolerance. If

How to Get Bavencio (avelumab) Covered by Aetna CVS Health in Florida: Complete Prior Authorization Guide

Quick Answer: Getting Bavencio Covered by Aetna CVS Health in Florida Bavencio (avelumab) requires prior authorization from Aetna CVS Health for all Florida members. Submit the Aetna Bavencio precertification form with complete clinical documentation through CVS Specialty Pharmacy. Most approvals take 30-45 days; expedited decisions within 72 hours for urgent

How to Get iLink® Corneal Cross-Linking Covered by Aetna CVS Health in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Getting iLink® Covered by Aetna CVS Health in Illinois Eligibility: Aetna CVS Health covers FDA-approved iLink® corneal cross-linking for progressive keratoconus when you have documented disease progression via serial corneal topography (3-6 months apart) and minimum 400-micron corneal thickness. Fastest Path: 1) Gather serial topography and pachymetry from

How to Get Hemgenix (etranacogene dezaparvovec) Covered by Aetna CVS Health in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Hemgenix Covered by Aetna CVS Health in Florida Fastest path to approval: Submit prior authorization with Factor IX activity ≤2%, negative inhibitor test, documented prophylaxis failure (≥150 exposure days), and hematologist attestation. First step today: Contact your hemophilia treatment center to begin gathering required labs and treatment

How to Get Isturisa (Osilodrostat) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Isturisa Covered by Aetna CVS Health in North Carolina Fastest path to approval: Submit Aetna's specialty medication prior authorization form through the Availity provider portal with complete documentation: confirmed Cushing's disease diagnosis, failed pituitary surgery or contraindication, and prescription from an endocrinologist. Standard

Myths vs. Facts: Getting Emgality (galcanezumab-gnlm) Covered by Aetna (CVS Health) in Michigan

Answer Box: Getting Emgality Covered by Aetna in Michigan Fast Facts: Aetna (CVS Health) requires prior authorization for Emgality (galcanezumab-gnlm) with documented failure of two generic migraine preventives. If denied, you have 180 days for internal appeals, then 127 days for Michigan DIFS external review. First step today: Request your

Getting Qalsody (Tofersen) Covered by Aetna CVS Health in Michigan: ICD-10, HCPCS J-Code, and Billing Guide

Answer Box: Fast Track to Qalsody Coverage Aetna CVS Health requires prior authorization for Qalsody (tofersen) in Michigan using specific coding and documentation requirements. Use ICD-10 code G12.21 for ALS diagnosis, HCPCS J-code J1304 for billing, and NDC 64406-0109-01 for drug identification. Submit complete documentation including SOD1 genetic test