Topic

Aetna (CVS Health)

A collection of 1074 issues

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

How to Get Nourianz (Istradefylline) Approved by Aetna CVS Health in Pennsylvania: Step-by-Step Prior Authorization Guide

Answer Box: Getting Nourianz (Istradefylline) Approved by Aetna CVS Health in Pennsylvania Aetna CVS Health requires prior authorization for Nourianz (istradefylline) with step therapy requirements in Pennsylvania. You'll need documented failure of amantadine, MAO-B inhibitors (like rasagiline), or COMT inhibitors (like entacapone), plus proof of 3+ hours daily

How to Get Naglazyme (galsulfase) Covered by Aetna (CVS Health) in Washington: Complete PA Guide & Appeal Scripts

Answer Box: Getting Naglazyme (galsulfase) Covered by Aetna (CVS Health) in Washington Naglazyme (galsulfase) requires prior authorization from Aetna (CVS Health) as a Tier 5 specialty medication for MPS VI (Maroteaux-Lamy syndrome). Your fastest path to approval: (1) Submit PA with confirmed enzyme/genetic testing showing ARSB deficiency, (2) Include

How to Get Rinvoq (upadacitinib) Covered by Aetna (CVS Health) in Virginia: Complete Guide with Forms, Timelines, and Appeal Scripts

Answer Box: Fastest Path to Rinvoq (upadacitinib) Coverage Aetna (CVS Health) requires prior authorization for Rinvoq (upadacitinib) in Virginia, mandating documented failure or intolerance to at least one TNF inhibitor. Submit your PA request via Aetna's provider portal or CoverMyMeds with complete clinical documentation including prior therapy records,

Renewing Naglazyme (Galsulfase) Approval with Aetna (CVS Health) in Michigan: 2025 Timeline and Documentation Guide

Quick Answer: Renewing Your Naglazyme Coverage Start renewal 60-90 days before expiration. Contact your metabolic specialist to update functional assessments (6-minute walk test, stair climbing capacity) and prepare a medical necessity letter documenting continued clinical benefit. Submit through CVS Specialty Pharmacy or CoverMyMeds portal. If denied, you have 180 days

Aetna's Coverage Criteria for Hemlibra (emicizumab-kxwh) in Michigan: What Counts as "Medically Necessary"?

Answer Box: Getting Hemlibra Covered by Aetna in Michigan Aetna requires prior authorization for Hemlibra (emicizumab-kxwh) with medical necessity established through confirmed hemophilia A diagnosis, routine prophylaxis indication, and hematologist prescription. Michigan patients have strong appeal rights through DIFS external review within 127 days of denial. First step today: Contact

How to Get Aldurazyme (Laronidase) Covered by Aetna CVS Health in Texas: Complete Prior Authorization & Appeals Guide

Quick Answer: Getting Aldurazyme Covered by Aetna CVS Health in Texas Aldurazyme (laronidase) requires prior authorization for all Aetna CVS Health plans in Texas. The fastest path to approval: have your MPS I specialist submit a complete PA packet via Availity portal with genetic/enzymatic confirmation, baseline assessments, and monitoring

Work With Your Doctor to Get Onpattro (patisiran) Approved by Aetna CVS Health in California

Answer Box: Getting Started Today Onpattro (patisiran) requires prior authorization from Aetna CVS Health for hereditary transthyretin amyloidosis polyneuropathy (hATTR-PN). Your fastest path: schedule a neurologist visit to confirm genetic testing (TTR variant), baseline mNIS+7 score, and 6-minute walk test. Submit Aetna's precertification form with complete documentation.

How to Get Taltz (Ixekizumab) Covered by Aetna CVS Health in Georgia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Taltz Covered by Aetna CVS Health in Georgia Taltz (ixekizumab) requires prior authorization from Aetna CVS Health in Georgia, with step therapy requirements for most plans. Your fastest path to approval: (1) Have your dermatologist or rheumatologist submit a PA through the Aetna provider portal with documentation

Aetna (CVS Health) Coverage Criteria for Prolastin-C in Florida: What Counts as "Medically Necessary"?

Answer Box To get Prolastin-C covered by Aetna (CVS Health) in Florida, you need: 1) Confirmed severe AAT deficiency (Pi*ZZ genotype + serum AAT <57 mg/dL), 2) Post-bronchodilator FEV₁ between 25-80% predicted, and 3) Documentation of emphysema/COPD due to AAT deficiency. Submit prior authorization using Aetna'