Topic

Aetna (CVS Health)

A collection of 139 issues

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.

How to Get Orkambi (lumacaftor/ivacaftor) Covered by Aetna (CVS Health) in North Carolina: Complete Approval Guide

Answer Box: Get Orkambi Covered by Aetna in North Carolina Fastest Path to Approval: Aetna requires prior authorization for Orkambi with genetic testing confirming F508del homozygosity, pulmonologist prescription, and documentation of cystic fibrosis diagnosis. Submit through CVS Caremark specialty pharmacy with complete documentation. If denied, use North Carolina's

How to Get Joenja (leniolisib) Covered by Aetna (CVS Health) in North Carolina: Complete Guide to Prior Authorization, Appeals, and Cost Assistance

Answer Box: Getting Joenja (leniolisib) Covered by Aetna (CVS Health) in North Carolina Joenja (leniolisib) requires prior authorization from Aetna (CVS Health) with genetic confirmation of APDS, specialist prescriber, and patient meeting age/weight criteria (≥12 years, ≥45 kg). The medication costs $250 per 30-day supply on the specialty tier,

How to Get Ilaris (Canakinumab) Covered by Aetna CVS Health in New Jersey: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Ilaris Covered by Aetna CVS Health in New Jersey Ilaris (canakinumab) requires prior authorization from Aetna CVS Health for all New Jersey members. The fastest path to approval: have your rheumatologist or immunologist complete Aetna's Ilaris precertification form with documentation of your diagnosis (Still'

How to Get Rylaze Approved by Aetna CVS Health in New Jersey: Timeline, Appeals, and Success Strategies

Answer Box: Getting Rylaze Covered by Aetna CVS Health in New Jersey Rylaze (asparaginase erwinia chrysanthemi recombinant) requires prior authorization from Aetna CVS Health. The fastest path to approval: (1) Document hypersensitivity to E. coli asparaginase with clinical notes showing reaction details, (2) Submit complete PA request via Availity portal

How to Get Ofev (nintedanib) Covered by Aetna CVS Health in California: Prior Authorization Guide and Appeals Process

Answer Box: Getting Ofev (nintedanib) Covered by Aetna CVS Health in California Ofev (nintedanib) is covered by Aetna CVS Health as a Tier 4 specialty drug with strict prior authorization requirements. You'll need HRCT showing ≥10% lung fibrosis, recent PFTs (FVC ≥45% predicted), and evidence of disease progression

How to Get Kuvan (Sapropterin) Covered by Aetna CVS Health in New Jersey: Complete Appeals Guide

Answer Box: Your Fastest Path to Kuvan Coverage Aetna CVS Health requires prior authorization for Kuvan (sapropterin) in New Jersey. Start by having your metabolic specialist submit a PA request through Aetna's Availity portal with complete PKU documentation, baseline phenylalanine levels, and dietary management records. If denied, you

How to Get Signifor LAR (Pasireotide) Covered by Aetna in Michigan: Prior Authorization Forms and Appeal Guide

Answer Box: Getting Signifor LAR Covered by Aetna in Michigan Aetna requires prior authorization for Signifor LAR (pasireotide) in Michigan. You must document trial and failure of Somatuline Depot (lanreotide) first, plus provide biochemical evidence (elevated UFC for Cushing's disease or IGF-1 for acromegaly). Submit via CVS Specialty

Myths vs. Facts: Getting Helixate (antihemophilic factor, rFVIII) Covered by Aetna (CVS Health) in California

Answer Box: Helixate Coverage Through Aetna (CVS Health) in California Helixate (recombinant factor VIII) requires prior authorization from Aetna (CVS Health) and may face coverage challenges due to product discontinuation in the US. Alternative rFVIII products like Kovaltry or Jivi are typically covered with proper documentation. In California, if denied,