Topic

Aetna (CVS Health)

A collection of 1144 issues

How to Get Kanuma (sebelipase alfa) Covered by Aetna (CVS Health) in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Kanuma Covered by Aetna (CVS Health) in Virginia Kanuma (sebelipase alfa) requires prior authorization from Aetna (CVS Health) in Virginia. Your fastest path to approval: 1) Gather LAL enzyme activity results (<10% normal) and LIPA gene testing confirming pathogenic variants, 2) Submit Aetna's Kanuma-specific

Do You Qualify for Crysvita (burosumab) Coverage by Aetna (CVS Health) in Michigan? Decision Tree & Next Steps

Quick Answer: Your Path to Coverage Yes, most Michigan patients with confirmed XLH or TIO can get Crysvita covered by Aetna (CVS Health), but prior authorization is always required. The fastest path: (1) Confirm genetic testing shows PHEX mutation or biochemical evidence of elevated FGF23 with low serum phosphorus, (2)

How to Get Epidiolex (Cannabidiol) Covered by Aetna (CVS Health) in Georgia: Complete Provider Collaboration Guide with Appeals Process

Answer Box: Getting Epidiolex Covered in Georgia Epidiolex (cannabidiol) requires prior authorization from Aetna (CVS Health) for FDA-approved seizure conditions (Dravet syndrome, Lennox-Gastaut syndrome, tuberous sclerosis complex) in patients ≥1 year old. Your fastest path: (1) Partner with your neurologist to document failed prior anti-seizure medications, (2) Submit a comprehensive

Get Arikayce Covered by Aetna CVS Health in California: Prior Authorization, Appeals, and Coding Guide

Quick Answer: Getting Arikayce Covered by Aetna CVS Health in California Arikayce (amikacin liposome inhalation) requires prior authorization from Aetna CVS Health for refractory MAC lung disease. Submit your PA request through the Availity provider portal or call 1-866-814-5506. You'll need documentation of 6+ months of failed multidrug

Getting Cystadane (Betaine Anhydrous) Covered by Aetna CVS Health in Illinois: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Cystadane Covered by Aetna in Illinois Yes, Aetna CVS Health covers Cystadane (betaine anhydrous) with prior authorization. The fastest path: Submit PA request through Availity provider portal with genetic confirmation of homocystinuria, documented vitamin therapy trials, and current lab values. If denied, you have 180 days to

How to Get Tepezza (Teprotumumab) Covered by Aetna CVS Health in Illinois: Prior Authorization Forms, Appeals Process, and Alternative Options

Quick Answer: Getting Tepezza Covered by Aetna CVS Health in Illinois Tepezza (teprotumumab) requires prior authorization from Aetna CVS Health in Illinois. You'll need documentation of moderate-to-severe thyroid eye disease, failure or contraindication to corticosteroids, and ophthalmology consultation. If denied, Illinois law provides strong appeal rights including independent

Amondys 45 (Casimersen) Approval with Aetna (CVS Health) in New Jersey: Complete Guide to Prior Authorization, Appeals, and Coverage Requirements

Quick Answer: Getting Amondys 45 (Casimersen) Covered by Aetna (CVS Health) in New Jersey Eligibility: DMD patients with exon 45-amenable mutations, under 14 at treatment start, able to walk ≥300 meters independently, prescribed by a neuromuscular specialist. Fastest path: Submit complete prior authorization with genetic test report, 6-minute walk test

How to Get Hetlioz (tasimelteon) Covered by Aetna CVS Health in California: Complete Guide to Forms, Appeals, and PA Requirements

Answer Box: Getting Hetlioz Covered by Aetna CVS Health in California Hetlioz (tasimelteon) requires prior authorization from Aetna CVS Health and is dispensed through specialty pharmacy only. Key requirements include confirmed diagnosis (Non-24 or Smith-Magenis syndrome), specialist attestation, and documented failure of melatonin therapy. Submit PA requests via provider portal

Do You Qualify for Voxzogo (Vosoritide) Coverage by Aetna CVS Health in New Jersey? Complete Decision Tree & Appeals Guide

Answer Box: Voxzogo Coverage by Aetna CVS Health in New Jersey Who qualifies: Children with achondroplasia, open growth plates, and specialist prescription. Fastest path: Gather genetic testing (FGFR3 mutation), growth plate imaging, and baseline growth data. Submit PA through CVS Caremark at 1-800-294-5979. If denied: Use New Jersey's

How to Get Alprolix (Eftrenonacog Alfa) Covered by Aetna CVS Health in Washington: Complete Coding, Prior Authorization & Appeals Guide

Answer Box: Getting Alprolix Approved by Aetna CVS Health in Washington Alprolix (eftrenonacog alfa) requires prior authorization from Aetna CVS Health with proper coding and documentation. Use ICD-10 code D67 for hemophilia B, HCPCS code J7202 for billing, and ensure your hematologist submits complete clinical justification. If denied, Washington residents