Topic

Aetna (CVS Health)

A collection of 1073 issues

Do You Qualify for Helixate Coverage by Aetna CVS Health in Illinois? Decision Tree & Next Steps

Answer Box: Getting Helixate Covered by Aetna CVS Health in Illinois Helixate (antihemophilic factor, rFVIII) requires prior authorization with Aetna CVS Health and is typically covered for confirmed hemophilia A when medically necessary. Note: Kogenate FS was discontinued in 2022-2023, so patients need alternatives like Kovaltry, Jivi, or other factor

How to Get Elelyso (taliglucerase alfa) Covered by Aetna CVS Health in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Started Elelyso (taliglucerase alfa) requires prior authorization from Aetna CVS Health for Type 1 Gaucher disease. In Ohio, the fastest path to approval involves: 1) Confirming your diagnosis with enzyme testing and genetic results, 2) Using Aetna's Medical Exception/Prior Authorization form with complete clinical

How to Get Galafold (migalastat) Covered by Aetna (CVS Health) in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Fastest Path to Galafold Approval in Illinois To get Galafold (migalastat) covered by Aetna (CVS Health) in Illinois, you need: (1) confirmed Fabry disease with an amenable GLA variant documented by genetic testing, (2) prescription from a specialist (genetics/nephrology), and (3) prior authorization showing no concurrent enzyme

How to Get Chenodal (chenodiol) Covered by Aetna (CVS Health) in Virginia: Prior Authorization Guide and Appeals Process

Answer Box: Getting Chenodal (chenodiol) Covered by Aetna (CVS Health) in Virginia Fastest Path: Aetna (CVS Health) typically requires prior authorization for Chenodal (chenodiol) and often mandates trying ursodiol first (step therapy). To get approval in Virginia: (1) Have your doctor submit a prior authorization request with imaging confirming radiolucent

How to Get Kymriah (tisagenlecleucel) Covered by Aetna (CVS Health) in North Carolina: Complete Guide to Prior Authorization, Appeals, and Coding

Answer Box: Fast Track to Kymriah Coverage Aetna (CVS Health) requires prior authorization for Kymriah (tisagenlecleucel) in North Carolina. Your fastest path: (1) Confirm CD19-positive pathology and treatment at an Aetna-contracted CAR-T center, (2) Submit PA with complete treatment history via 1-877-212-8811, and (3) Request expedited review (≤72 hours) if

How to Get Daybue (trofinetide) Covered by Aetna CVS Health in Georgia: Complete Requirements Checklist and Appeal Guide

Quick Answer: Getting Daybue Covered by Aetna CVS Health in Georgia Aetna CVS Health requires prior authorization for Daybue (trofinetide) with no step therapy requirements. You'll need confirmed Rett syndrome diagnosis via MECP2 genetic testing, patient age ≥2 years, and specialist prescription. Submit through Aetna provider portal with

How to Get Rapivab (Peramivir) Covered by Aetna CVS Health in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Rapivab Covered by Aetna CVS Health in Ohio Rapivab (peramivir) requires prior authorization through Aetna CVS Health as a specialty drug, typically filled via CVS Specialty Pharmacy. Key requirements: confirmed influenza diagnosis within 48 hours of symptom onset, documented contraindications to oral alternatives (oseltamivir/zanamivir), and medical

How to Get Cystadane (Betaine Anhydrous) Covered by Aetna CVS Health in Virginia: Prior Authorization Guide and Appeals Process

Answer Box: Getting Cystadane (Betaine Anhydrous) Covered by Aetna CVS Health in Virginia Cystadane (betaine anhydrous) requires prior authorization from Aetna CVS Health in Virginia. Submit genetic testing confirmation of homocystinuria, current homocysteine/methionine lab values, and documentation of vitamin therapy trials (B6, B12, folate) via Availity portal for fastest

How to Get Venclexta (venetoclax) Covered by Aetna (CVS Health) in New York: Complete PA Guide and Appeals Process

Answer Box: Get Venclexta (venetoclax) Covered by Aetna (CVS Health) in New York Venclexta requires prior authorization from Aetna (CVS Health) with step therapy requirements (documented BTK inhibitor failure for CLL) and mandatory tumor lysis syndrome prevention plans. Submit via CVS Caremark provider portal with complete medical records, FDA indication

How to Get Enbrel (etanercept) Covered by Aetna CVS Health in Washington: Complete Coding, Appeals & Authorization Guide

Answer Box: Getting Enbrel (etanercept) Covered by Aetna CVS Health in Washington Quick path to approval: Submit prior authorization through Aetna's provider portal with proper ICD-10 codes (M05.9 for RA, M06.9 for seronegative RA), HCPCS J1438 billing code, tuberculosis/hepatitis B screening results, and documented failures