Topic

Aetna (CVS Health)

A collection of 1288 issues

How to Get Mepsevii (Vestronidase Alfa-vjbk) Covered by Aetna CVS Health in Georgia: Prior Authorization Guide and Appeals Process

Answer Box: Getting Mepsevii Covered by Aetna CVS Health in Georgia Mepsevii (vestronidase alfa-vjbk) requires prior authorization from Aetna CVS Health with confirmed MPS VII diagnosis via enzyme assay or genetic testing, prescription by a metabolic specialist, and elevated urinary glycosaminoglycans (uGAG) ≥2x normal levels. Submit the Aetna Mepsevii precertification

How to Get Humira (adalimumab) Covered by Aetna (CVS Health) in Texas: 2024 Forms, Appeals, and Renewal Guide

Answer Box: Getting Humira (adalimumab) Covered by Aetna (CVS Health) in Texas Aetna (CVS Health) requires prior authorization for Humira (adalimumab) in Texas, typically favoring biosimilars first through step therapy. However, Texas fully insured members on Basic Control and Advanced Control plans are exempt from step therapy requirements. Fastest path:

How to Get Tavneos (Avacopan) Covered by Aetna CVS Health in North Carolina: Complete Guide to Prior Authorization, Appeals, and Alternative Pathways

Answer Box: Your Path to Coverage Getting Tavneos (avacopan) covered by Aetna CVS Health in North Carolina requires prior authorization with documentation of severe active ANCA-associated vasculitis (GPA/MPA), use alongside standard therapies (rituximab/cyclophosphamide), and specialist prescribing. If denied, you have 180 days for internal appeals, then 120 days

How to Get Myalept (Metreleptin) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Myalept Covered by Aetna CVS Health in North Carolina Myalept (metreleptin) requires precertification from Aetna CVS Health, with initial approval needing confirmed generalized lipodystrophy diagnosis, leptin deficiency (<12 ng/mL), and at least one metabolic complication. If denied, North Carolina residents can appeal internally through Aetna

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

Answer Box: Getting Tracleer (Bosentan) Approved by Aetna (CVS Health) in Texas Aetna (CVS Health) requires prior authorization for Tracleer (bosentan) as a specialty medication for pulmonary arterial hypertension (PAH), with mandatory REMS program enrollment due to liver and pregnancy risks. Your fastest path to approval: (1) Confirm WHO Group

How Long Does It Take to Get Jynarque (tolvaptan) Approved by Aetna (CVS Health) in Michigan? Timeline & Appeal Process

Answer Box: Getting Jynarque (tolvaptan) Covered by Aetna (CVS Health) in Michigan Aetna (CVS Health) requires prior authorization for Jynarque (tolvaptan) in Michigan, processed through CVS Specialty Pharmacy. Standard approval takes up to 9 calendar days under Michigan law, with urgent requests decided within 72 hours. The process involves REMS

How to Get Rapivab (Peramivir) Covered by Aetna CVS Health in Texas: Appeals Guide and Forms

Answer Box: Getting Rapivab (Peramivir) Covered by Aetna CVS Health in Texas Rapivab requires prior authorization from Aetna CVS Health for IV influenza treatment. Submit PA within 48 hours of symptom onset with lab-confirmed flu test and documentation why oral antivirals can't be used. Standard decisions take 30-45

How to Get Revcovi (Elapegademase) Covered by Aetna CVS Health in Ohio: Complete PA Guide with Appeals Process

Answer Box: Fastest Path to Revcovi Coverage in Ohio Revcovi (elapegademase) is covered on Aetna CVS Health's specialty tier with prior authorization required. For ADA-SCID patients in Ohio: (1) Verify your plan type—HMO requires PCP referral to immunologist, PPO allows direct access; (2) Submit complete PA documentation

How to Get Rylaze (asparaginase erwinia chrysanthemi [recombinant]-rywn) Covered by Aetna (CVS Health) in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Rylaze Covered by Aetna in North Carolina Aetna requires prior authorization for Rylaze (asparaginase erwinia chrysanthemi [recombinant]-rywn) in North Carolina patients ≥1 month old with ALL/LBL who developed hypersensitivity to E. coli asparaginase. Submit PA through Aetna's provider portal with documented hypersensitivity reactions,

How to Get Kineret (anakinra) Covered by Aetna (CVS Health) in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Kineret (anakinra) Approved by Aetna (CVS Health) in Florida Aetna (CVS Health) requires prior authorization for Kineret (anakinra) with specific criteria: moderately to severely active rheumatoid arthritis in adults 18+, prescription from a rheumatologist, and documented failure of at least one traditional DMARD like methotrexate. Submit your