Topic

Aetna (CVS Health)

A collection of 137 issues

Getting Oxbryta (Voxelotor) Covered by Aetna CVS Health in Virginia: 2024 Updates, Appeals, and Alternatives

Quick Answer: Oxbryta Coverage Status in Virginia Important Update: Oxbryta (voxelotor) is no longer FDA-approved in the United States as of 2024. Pfizer withdrew the drug following a confirmatory evidence review. If you're in Virginia with Aetna CVS Health coverage and need sickle cell disease treatment, focus on

How to Get Evrysdi (risdiplam) Covered by Aetna (CVS Health) in Pennsylvania: Forms, Appeals, and Contact Guide

Quick Answer: Evrysdi (risdiplam) requires prior authorization from Aetna (CVS Health) in Pennsylvania. Submit PA requests via the Availity provider portal with genetic confirmation, neurologist documentation, and motor function assessments. If denied, you have 180 days to appeal internally, then 4 months for Pennsylvania's external review program. Start

How to Get Elelyso (taliglucerase alfa) Covered by Aetna in Pennsylvania: Complete Approval Guide with Forms and Appeal Scripts

Answer Box: Getting Elelyso Covered by Aetna in Pennsylvania Elelyso (taliglucerase alfa) requires prior authorization from Aetna CVS Health in Pennsylvania. The fastest path to approval: 1) Confirm Type 1 Gaucher disease diagnosis with enzyme assay and genetic testing, 2) Submit PA request via Aetna provider portal with specialist documentation,

Renewing Eylea/Lucentis Approval with Aetna CVS Health in North Carolina: 2024 Timeline and Requirements

Answer Box: Quick Start for North Carolina Residents If your Eylea or Lucentis authorization is expiring with Aetna CVS Health: Start renewal 30-45 days early. You'll need updated OCT imaging, current visual acuity measurements, and documentation of continued medical necessity. Submit through your eye doctor's office

How to Get Amvuttra (vutrisiran) Approved by Aetna CVS Health in California: Formulary Alternatives, PA Requirements & Appeal Scripts

Answer Box: Getting Amvuttra Covered by Aetna CVS Health in California Aetna CVS Health requires prior authorization for Amvuttra (vutrisiran) with documented genetic testing, specialist evaluation, and evidence of failure/intolerance to preferred alternatives like tafamidis or patisiran. In California, standard PA decisions take 72 hours; urgent requests get 24-hour

How Long Does It Take to Get Ilaris (Canakinumab) Approved by Aetna CVS Health in Texas? Complete Timeline Guide

Answer Box: Getting Ilaris (Canakinumab) Covered by Aetna CVS Health in Texas Standard approval timeline: 30-45 days for prior authorization, with over 95% of eligible requests processed within 24 hours. Expedited reviews for urgent cases must be completed within 72 hours under Texas law. Fastest path to approval: 1. Prescriber

Work With Your Doctor to Get Ruconest Covered by Aetna CVS Health in Virginia: Provider Collaboration Guide

Quick Answer: Your Path to Ruconest Coverage Getting Ruconest (C1 esterase inhibitor [recombinant]) covered by Aetna CVS Health in Virginia requires prior authorization with specific lab documentation proving hereditary angioedema (HAE). Your fastest path: schedule an appointment with an HAE specialist (allergist/immunologist), gather your C1-INH and C4 lab results,

Work With Your Doctor to Get Opdivo (Nivolumab) Approved by Aetna CVS Health in Texas: Complete Guide

Answer Box: Your Fastest Path to Opdivo Coverage in Texas Aetna CVS Health requires prior authorization for Opdivo (nivolumab) in Texas. Work directly with your oncologist to submit a complete precertification request through the Availity provider portal at least two weeks before planned treatment. If denied, you have 180 days

How to Get Emflaza (Deflazacort) Covered by Aetna CVS Health in Illinois: Complete Prior Authorization Guide

Quick Answer: Getting Emflaza Covered by Aetna CVS Health in Illinois Yes, Aetna CVS Health covers Emflaza (deflazacort) for Duchenne muscular dystrophy in Illinois, but requires prior authorization and step therapy. You must first try and fail prednisone or prednisolone due to documented side effects. Your neurologist submits the PA

How to Get Gilenya (Fingolimod) Covered by Aetna CVS Health in Georgia: Prior Authorization Forms and Appeals Guide

Quick Answer: Getting Gilenya Covered by Aetna CVS Health in Georgia Gilenya (fingolimod) requires prior authorization from Aetna CVS Health and must meet specific medical necessity criteria. You'll need documentation of your relapsing MS diagnosis (ICD-10 code G35), baseline EKG, ophthalmic exam, and evidence of failed first-line treatments.