Topic

Aetna (CVS Health)

A collection of 1288 issues

How to Get Elfabrio (pegunigalsidase alfa-iwxj) Covered by Aetna (CVS Health) in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Elfabrio Covered by Aetna in Ohio Aetna (CVS Health) requires prior authorization for Elfabrio (pegunigalsidase alfa-iwxj) with confirmed Fabry disease diagnosis and specialist prescription. The fastest path: (1) Gather genetic testing/enzyme levels confirming Fabry disease, (2) Have your specialist submit via Aetna's provider portal
6 min read

How Long Does It Take to Get Somatuline Depot (Lanreotide) Approved by Aetna CVS Health in New York? Complete Timeline Guide

Answer Box: Getting Somatuline Depot Approved by Aetna CVS Health in New York Aetna CVS Health requires prior authorization for Somatuline Depot (lanreotide) with typical processing taking 2-45 days depending on submission method and completeness. Electronic submissions via Availity process fastest (24-72 hours), while standard requests take 30-45 days. First
5 min read

Getting Upstaza (Eladocagene Exuparvovec) Covered by Aetna CVS Health in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Upstaza Coverage To get Upstaza (eladocagene exuparvovec) covered by Aetna CVS Health in Michigan: Submit prior authorization with genetic confirmation of AADC deficiency, FDA approval documentation, and medical necessity letter from a certified neurosurgical center. If denied, file internal appeal within 180 days, then external
5 min read

Getting Trikafta (Elexacaftor/Tezacaftor/Ivacaftor) Covered by Aetna CVS Health in Michigan: Prior Authorization, Appeals, and Alternative Options

Quick Answer: Getting Trikafta Covered by Aetna CVS Health in Michigan Trikafta requires prior authorization from Aetna CVS Health with CFTR genotype testing (≥1 F508del mutation), cystic fibrosis diagnosis (ICD-10 E84.x), age ≥2 years, and baseline liver function tests. Submit via CVS Caremark Specialty pharmacy with 2+ weeks lead
6 min read

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Aetna CVS Health in Florida: Complete Prior Authorization Guide and Appeals Process

Answer Box: Getting Enhertu Covered by Aetna CVS Health in Florida Enhertu (fam-trastuzumab deruxtecan-nxki) requires prior authorization from Aetna CVS Health for all FDA-approved indications. The fastest path to approval: (1) Submit Aetna's Enhertu precertification form (GR-69531 5-24) with HER2 testing results and prior therapy documentation, (2) Include
6 min read

How to Get Tremfya (Guselkumab) Covered by Aetna CVS Health in Texas: Complete 2024 Guide with Forms and Appeal Scripts

Answer Box: Getting Tremfya Covered by Aetna CVS Health in Texas Tremfya (guselkumab) requires prior authorization from Aetna CVS Health for psoriasis, psoriatic arthritis, and ulcerative colitis. Success requires documenting moderate-to-severe disease, trials/failures of preferred biologics (like Humira or TNF inhibitors), and negative TB screening. Submit via specialist through
6 min read

If Abecma Isn't Approved by Aetna (CVS Health) in Georgia: Formulary Alternatives & Exception Paths

Answer Box: If Aetna (CVS Health) denies Abecma (idecabtagene vicleucel) coverage in Georgia, alternatives include Carvykti (cilta-cel) CAR-T therapy or teclistamab bispecific therapy for relapsed/refractory multiple myeloma. Request a formulary exception through your oncologist by documenting medical necessity with prior treatment failures and NCCN guideline support. File internal appeals
5 min read