Topic

Aetna (CVS Health)

A collection of 1288 issues

How to Get Cimzia (Certolizumab Pegol) Covered by Aetna CVS Health in California: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Cimzia Approved by Aetna CVS Health in California Cimzia (certolizumab pegol) requires prior authorization from Aetna CVS Health and faces step therapy requirements favoring preferred biologics. Success requires documenting failed trials of preferred TNF inhibitors (like Humira or infliximab biosimilars), negative TB/hepatitis B screening, and meeting

How to Get Signifor LAR (Pasireotide) Covered by Aetna CVS Health in Ohio: Complete Prior Authorization Guide with Appeals Timeline

Answer Box: Getting Signifor LAR Covered by Aetna CVS Health in Ohio Signifor LAR (pasireotide) requires prior authorization from Aetna CVS Health and is non-preferred on their formulary. To get coverage in Ohio: (1) Submit complete PA documentation showing elevated cortisol/IGF-1 levels, surgical failure/contraindication, and specialist prescriber, (2)

How to Get Photrexa (Riboflavin) Covered by Aetna CVS Health in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Photrexa Covered by Aetna CVS Health in Florida Photrexa (riboflavin ophthalmic solution) requires prior authorization from Aetna CVS Health in Florida. Submit PA request through Availity provider portal with: keratoconus progression documentation (Kmax values), failed conservative treatments, FDA-approved iLink system confirmation. Standard decision: 30-45 days. If denied,

Do You Qualify for Aldurazyme (laronidase) Coverage by Aetna (CVS Health) in Washington? Decision Tree & Next Steps

Answer Box: Qualifying for Aldurazyme Coverage Yes, you likely qualify for Aldurazyme (laronidase) coverage by Aetna (CVS Health) in Washington if you have confirmed MPS I via enzyme assay or genetic testing. Aetna covers Aldurazyme as a specialty tier drug requiring prior authorization for Hurler, Hurler-Scheie, or moderate-to-severe Scheie forms.

How to Get Signifor / Signifor LAR (pasireotide) Covered by Aetna (CVS Health) in Florida: Complete PA Forms and Appeals Guide

Quick Answer: Getting Signifor / Signifor LAR (pasireotide) Covered by Aetna (CVS Health) in Florida Signifor / Signifor LAR (pasireotide) requires prior authorization from Aetna (CVS Health) in Florida. For acromegaly, you'll need documented failure of first-generation somatostatin analogs (octreotide, lanreotide) plus elevated IGF-1 levels. For Cushing's disease,

The Requirements Checklist to Get Entresto (Sacubitril/Valsartan) Covered by Aetna (CVS Health) in Washington

Quick Answer: Getting Entresto Approved Entresto requires prior authorization from Aetna (CVS Health) for heart failure patients with LVEF ≤40%. To get approved in Washington: 1) Gather recent echocardiogram showing reduced ejection fraction, 2) Document ACE inhibitor or ARB trial failure, 3) Submit via Aetna provider portal. If denied, you

How to Get Mepsevii (Vestronidase Alfa-vjbk) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Mepsevii Covered by Aetna CVS Health in Virginia Mepsevii (vestronidase alfa-vjbk) requires prior authorization from Aetna CVS Health under Clinical Policy Bulletin 0442. Key requirements: confirmed MPS VII diagnosis via enzyme assay or genetic testing, prescription by a metabolic specialist, and elevated urinary glycosaminoglycans ≥2x normal levels.

How to Get Besponsa (inotuzumab ozogamicin) Covered by Aetna (CVS Health) in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Besponsa Covered in Virginia Aetna (CVS Health) requires prior authorization for Besponsa (inotuzumab ozogamicin) in Virginia. The fastest path to approval: 1) Confirm CD22-positive B-cell ALL with ≥5% blasts via flow cytometry, 2) Document relapsed/refractory status after ≥1 prior therapy, 3) Submit complete PA packet to

How to Get Takhzyro (lanadelumab-flyo) Covered by Aetna (CVS Health) in New York: Appeals Guide and State Protections

Answer Box: Quick Path to Coverage Getting Takhzyro (lanadelumab-flyo) covered by Aetna (CVS Health) in New York requires prior authorization and meeting specific HAE criteria. Start with your doctor submitting a PA request through CVS Caremark's provider portal, including confirmed HAE type I/II diagnosis (C4/C1-INH labs)

How to Get Kesimpta (Ofatumumab) Covered by Aetna (CVS Health) in Georgia: Complete PA Guide and Appeal Scripts

Quick Answer: Aetna (CVS Health) requires prior authorization for Kesimpta (ofatumumab) with documented relapsing MS diagnosis, neurologist prescription, and evidence of prior DMT failures or contraindications. In Georgia, you have 180 days to appeal internal denials and 60 days for external review through the Georgia Department of Insurance. Start by