Topic

Aetna (CVS Health)

A collection of 136 issues

How to Get Adynovate (Antihemophilic Factor) Covered by Aetna CVS Health in Illinois: Complete Prior Authorization Guide

Quick Answer: Getting Adynovate Covered by Aetna CVS Health in Illinois Adynovate requires prior authorization from Aetna CVS Health in Illinois. Submit requests through the Availity portal with complete hemophilia A documentation including Factor VIII activity levels, bleeding history, and medical necessity justification. If denied, you have 180 days to

How to Get Krystexxa (Pegloticase) Covered by Aetna CVS Health in Pennsylvania: Complete Coding, Appeals & Timeline Guide

Answer Box: Your Fastest Path to Krystexxa Coverage To get Krystexxa (pegloticase) covered by Aetna CVS Health in Pennsylvania: Submit a prior authorization with ICD-10 code M1A.*** (chronic gout), HCPCS J2507 (8 units per dose), documented failure of allopurinol and febuxostat, G6PD test results, and methotrexate co-therapy plan. If denied,

Getting Ozempic and Mounjaro Covered by Aetna CVS Health in Texas: Complete Prior Authorization Guide

Answer Box: How to Get Ozempic or Mounjaro Covered by Aetna CVS Health in Texas Both Ozempic (semaglutide) and Mounjaro (tirzepatide) require prior authorization from Aetna CVS Health in Texas. The fastest path to approval: 1) Have your doctor submit a prior authorization request with documented metformin failure and proper

Renewing Cystadane (Betaine Anhydrous) Coverage with Aetna CVS Health in Georgia: Timeline, Labs, and Appeal Rights

Answer Box: Renewing Your Cystadane Coverage Aetna CVS Health requires annual renewal for Cystadane (betaine anhydrous) in Georgia with specific lab documentation. Start your renewal 30-45 days before expiration. You'll need current homocysteine levels (goal: <15 µmol/L), methionine levels (<1,000 µmol/L for CBS

Renewing Humate-P Coverage with Aetna CVS Health in Florida: Timeline, Documentation & Bridge Options

Answer Box: Renewing Humate-P with Aetna CVS Health in Florida Start your Humate-P renewal 30-60 days before your current authorization expires. Submit updated clinical documentation including recent factor VIII/VWF labs, treatment response records, and adherence tracking through your provider's Aetna portal or specialty pharmacy. If coverage lapses,

How to Get Nucala (Mepolizumab) Covered by Aetna CVS Health in New York: Complete Guide with Forms and Appeal Process

Answer Box: Getting Nucala Covered by Aetna CVS Health in New York Yes, Nucala (mepolizumab) can be covered by Aetna CVS Health in New York, but requires prior authorization. You'll need a blood eosinophil count ≥150 cells/µL, documented failure of high-dose inhaled steroids plus another controller, and

How to Get Vyndaqel/Vyndamax (Tafamidis) Covered by Aetna CVS Health in North Carolina: Complete Guide to Prior Authorization, Appeals, and External Review

Answer Box: Getting Tafamidis Covered by Aetna CVS Health in North Carolina Quick Path to Approval: Aetna requires prior authorization for both Vyndaqel and Vyndamax (tafamidis) with confirmed ATTR-CM diagnosis via PYP scan or biopsy, NYHA Class I-III symptoms, and specialist prescriber. First step today: Verify your 2025 formulary status—

Renewing Fabrazyme (Agalsidase Beta) Coverage with Aetna in Virginia: Timeline, Documentation, and Bridge Options

Answer Box: Fabrazyme Renewal with Aetna in Virginia Key Steps: (1) Submit renewal documentation 30 days before current authorization expires, (2) Include updated specialist evaluation and lab results showing continued medical necessity, (3) Use Aetna's provider portal or fax to submit required forms. Timeline: Standard decisions within 14

How to Get Translarna (Ataluren) Covered by Aetna CVS Health in Virginia: Complete Timeline and Appeals Guide

Answer Box: Getting Translarna Covered by Aetna CVS Health in Virginia Important: Translarna (ataluren) is not FDA-approved in the United States as of 2025. However, if you're seeking coverage through expanded access or clinical trials, here's the fastest path: 1. Confirm genetic testing shows nonsense mutation

Myths vs. Facts: Getting Cosentyx (Secukinumab) Covered by Aetna (CVS Health) in California

Answer Box: Getting Cosentyx Covered by Aetna (CVS Health) in California Myth: If your doctor prescribes Cosentyx, Aetna must cover it. Fact: Aetna requires prior authorization, step therapy (trying preferred biologics first), and documented TB screening. Success depends on proper documentation of disease severity and prior treatment failures. Fastest path