Topic

Aetna (CVS Health)

A collection of 651 issues

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

How to Get Haegarda (C1-esterase inhibitor, SC) Covered by Aetna (CVS Health) in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Haegarda Covered by Aetna (CVS Health) in New Jersey Haegarda requires prior authorization from Aetna (CVS Health) in New Jersey. Your fastest path: 1) Have your HAE specialist complete Aetna's precertification form with HAE diagnosis confirmation (C1-INH deficiency labs), attack frequency documentation, and any prior

How to Get Fintepla (fenfluramine) Covered by Aetna CVS Health in Georgia: Complete Appeals Guide with Templates

Answer Box: Getting Fintepla Covered by Aetna CVS Health in Georgia Fastest path to approval: 1) Ensure REMS enrollment for prescriber, patient, and pharmacy via FinteplaREMS.com, 2) Document failed trials of preferred antiseizure medications with specific doses and outcomes, 3) Submit baseline echocardiogram showing no valvular disease. First step

How to Get Darzalex/Darzalex Faspro (Daratumumab) Approved by Aetna in Georgia: Prior Authorization Guide and Appeals Process

Quick Answer: Getting Darzalex/Darzalex Faspro Covered by Aetna in Georgia Aetna requires prior authorization for Darzalex (daratumumab) in Georgia. Your fastest path to approval: Have your oncologist complete Aetna's 2024 Darzalex precertification form with complete multiple myeloma documentation, including prior therapies tried and failed. Submit via fax

How to Get Vimizim (Elosulfase Alfa) Covered by Aetna in Illinois: Complete Prior Authorization Guide

Quick Answer: Getting Vimizim Covered by Aetna in Illinois Eligibility: Aetna covers Vimizim (elosulfase alfa) only for confirmed MPS IVA (Morquio A syndrome) with enzyme deficiency or genetic testing. Fastest path: Submit diagnostic proof (GALNS enzyme activity results or genetic test) plus clinical notes via Aetna's Availity portal

How to Get Dojolvi (Triheptanoin) Covered by Aetna CVS Health in California: Complete Timeline, Appeals Guide, and Required Documentation

Answer Box: Getting Dojolvi (Triheptanoin) Covered by Aetna CVS Health in California Fastest path to approval: Submit complete prior authorization through Aetna's provider portal with genetic confirmation of long-chain fatty acid oxidation disorder (LC-FAOD), specialist consultation notes, and medical necessity letter. Standard review takes 30 days; expedited review

How to Get Uplizna (Inebilizumab) Covered by Aetna CVS Health in California: Prior Authorization, Appeals, and State Protections Guide

Answer Box: Getting Uplizna (Inebilizumab) Covered by Aetna CVS Health in California Fast track to approval: Aetna requires prior authorization for Uplizna (inebilizumab) with proof of AQP4-positive NMOSD diagnosis and specialist involvement. California law provides strong appeal rights—including Independent Medical Review (IMR) with 68% success rates for specialty drugs

Getting Blenrep (Belantamab Mafodotin) Covered by Aetna CVS Health in Georgia: Appeals Guide and External Review Process

Answer Box: Blenrep Coverage Path for Georgia Residents Blenrep (belantamab mafodotin) is currently off-market in the US (withdrawn 2022, resubmission under FDA review). For Georgia residents with Aetna CVS Health, access is limited to clinical trials or expanded access programs. If denied coverage for trial participation or compassionate use: 1.

How to Get Zanzalintinib (XL092) Covered by Aetna in Georgia: Complete Appeals Guide and Compassionate Use Options

Answer Box: Your Fastest Path to Coverage Zanzalintinib (XL092) is investigational and typically not covered by Aetna outside clinical trials. However, you have two main pathways: 1) Apply for compassionate use through Exelixis while pursuing insurance appeals, or 2) Submit a formulary exception request with robust medical necessity documentation. In