Topic

Aetna (CVS Health)

A collection of 649 issues

How to Get Ocrevus (ocrelizumab) Covered by Aetna (CVS Health) in Ohio: Complete Appeals Guide with Forms and Scripts

Quick Answer: Getting Ocrevus Covered by Aetna in Ohio Aetna requires prior authorization for Ocrevus but doesn't mandate step therapy for FDA-approved MS indications. Submit complete clinical documentation including MS diagnosis confirmation, prior therapy history, and hepatitis B screening. If denied, request a peer-to-peer review immediately, then file

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Aetna CVS Health in New Jersey: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Enhertu Covered by Aetna CVS Health in New Jersey Enhertu (fam-trastuzumab deruxtecan-nxki) requires prior authorization from Aetna CVS Health for all FDA-approved indications. The fastest path to approval: 1) Submit complete PA request with HER2 biomarker testing, prior therapy documentation, and ILD monitoring plan via Aetna provider

Mavenclad (Cladribine) Approval with Aetna CVS Health in New Jersey: Complete Coverage Guide

Answer Box: Getting Mavenclad Covered by Aetna CVS Health in New Jersey Yes, Mavenclad (cladribine tablets) is covered by Aetna CVS Health in New Jersey with prior authorization for relapsing forms of multiple sclerosis. You need documented failure of at least two disease-modifying therapies and baseline lymphocyte count ≥800 cells/

How to Get Strimvelis Gene Therapy Covered by Aetna CVS Health in Texas: Complete Prior Authorization and Appeals Guide 2025

Answer Box: Getting Strimvelis Covered by Aetna CVS Health in Texas Strimvelis requires prior authorization from Aetna CVS Health with genetic confirmation of ADA-SCID, enzyme deficiency evidence, and proof no HLA-matched donor is available. Submit through Availity or fax (1-866-249-6155) with comprehensive clinical documentation. Standard review takes up to 45

How to Get Takhzyro (Lanadelumab) Covered by Aetna CVS Health in Pennsylvania: Complete Prior Authorization Guide

Answer Box: Get Takhzyro Covered by Aetna CVS Health in Pennsylvania To get Takhzyro (lanadelumab) covered by Aetna CVS Health in Pennsylvania, you need prior authorization with confirmed HAE diagnosis, specialist prescriber (allergist/immunologist), and documented failure of alternatives like Haegarda or Orladeyo. Submit your PA request via Aetna'

Aetna (CVS Health) Coverage Criteria for Joenja (leniolisib) in Illinois: What Counts as "Medically Necessary"?

Answer Box: Getting Joenja (leniolisib) Covered by Aetna (CVS Health) in Illinois Aetna (CVS Health) requires prior authorization for Joenja (leniolisib) with strict medical necessity criteria: genetic confirmation of APDS (PIK3CD or PIK3R1 mutation), patient age ≥12 years and weight ≥45 kg, and specialist prescriber (immunologist/hematologist). Fastest path: 1)

How to Get Evkeeza (Evinacumab) Approved by Aetna CVS Health in Illinois: Complete Prior Authorization Guide with Appeals Process

Answer Box: Getting Evkeeza Covered by Aetna CVS Health in Illinois Evkeeza (evinacumab) requires prior authorization from Aetna CVS Health for homozygous familial hypercholesterolemia (HoFH). The fastest path to approval: (1) Confirm HoFH diagnosis with genetic testing or clinical criteria, (2) Document failure of maximum-tolerated statin, ezetimibe, and PCSK9 inhibitor,

Get Retevmo (Selpercatinib) Approved by Aetna CVS Health in California: Complete Guide to Prior Authorization, Appeals & Timeline

Answer Box: Your Fastest Path to Retevmo Coverage Retevmo (selpercatinib) requires prior authorization from Aetna CVS Health in California. To get approved fastest: (1) Ensure RET alteration testing via FDA-approved methods like FoundationOne CDx is documented, (2) Have your oncologist submit the PA with complete clinical records through CVS Specialty&

Get Oxlumo (Lumasiran) Covered by Aetna CVS Health in Florida: Complete Guide with Forms and Appeals

Answer Box: Get Oxlumo Covered by Aetna in Florida Yes, Aetna CVS Health covers Oxlumo (lumasiran) for primary hyperoxaluria type 1 (PH1) in Florida with prior authorization. The fastest path to approval requires: (1) confirmed PH1 diagnosis via genetic testing or liver enzyme analysis, (2) prescription from a nephrology or

How to Get Joenja (Leniolisib) Covered by Aetna CVS Health in Florida: Complete Coding and Appeals Guide

Quick Answer: Getting Joenja (Leniolisib) Covered by Aetna CVS Health in Florida Joenja (leniolisib) requires prior authorization from Aetna CVS Health in Florida, with genetic testing documentation confirming APDS diagnosis. Use ICD-10 code D81.82, HCPCS code J8499, and NDC 71274-0170-60. Submit requests via the Availity provider portal or fax