Topic

Aetna (CVS Health)

A collection of 651 issues

Getting Rezlidhia (Olutasidenib) Covered by Aetna CVS Health in Virginia: Complete Guide to Prior Authorization, Appeals, and Patient Rights

Answer Box: Your Path to Coverage Rezlidhia (olutasidenib) requires prior authorization from Aetna CVS Health in Virginia. You're eligible if you have relapsed/refractory AML with a confirmed IDH1 mutation. Fastest path: Have your oncologist submit PA documentation including IDH1 test results, prior treatment history, and medical necessity

How to Get Cerezyme (Imiglucerase) Covered by Aetna CVS Health in Illinois: Complete Guide to Prior Authorization and Appeals

Quick Answer: Cerezyme requires prior authorization from Aetna CVS Health and is subject to step therapy (Elelyso preferred first). To get coverage: 1) Confirm Gaucher disease diagnosis with enzyme/genetic testing, 2) Document Elelyso trial/failure or contraindication, 3) Submit PA via provider portal with specialist support. If denied, Illinois

How to Get Vimizim (Elosulfase Alfa) Covered by Aetna (CVS Health) in Michigan: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Vimizim Covered by Aetna in Michigan Fastest Path to Approval: Aetna requires prior authorization for Vimizim (elosulfase alfa) with confirmed MPS IVA diagnosis through GALNS enzyme testing or genetic testing, plus documented clinical symptoms. Submit requests at least two weeks in advance through Aetna's provider

Get Defitelio (Defibrotide) Covered by Aetna CVS Health in New York: Prior Authorization Guide & Appeals Process

Answer Box: Getting Defitelio Covered by Aetna CVS Health in New York Defitelio (defibrotide) requires prior authorization from Aetna CVS Health for hepatic veno-occlusive disease (VOD)/sinusoidal obstruction syndrome (SOS) with organ dysfunction post-transplant. Key requirements: documented VOD/SOS diagnosis using Baltimore or Cairo criteria, evidence of renal or pulmonary

The Requirements Checklist to Get Natpara (Parathyroid Hormone) Covered by Aetna (CVS Health) in California

Quick Answer: Getting Natpara (parathyroid hormone) covered by Aetna (CVS Health) in California requires prior authorization with strict clinical documentation. You'll need confirmed hypoparathyroidism diagnosis, failed calcium/vitamin D therapy records, and endocrinologist support. Important: Takeda discontinued Natpara manufacturing globally in late 2024, with U.S. supply ending

How to Get Givlaari (givosiran) Covered by Aetna CVS Health in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Givlaari Covered by Aetna CVS Health in Pennsylvania Yes, Givlaari (givosiran) can be covered by Aetna CVS Health in Pennsylvania, but requires prior authorization. Submit your PA request through Availity.com with complete AHP documentation including elevated ALA/PBG levels and attack history. If denied, Pennsylvania'

How to Get Jakafi (Ruxolitinib) Covered by Aetna CVS Health in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Jakafi Covered by Aetna CVS Health in California Aetna CVS Health requires prior authorization for Jakafi (ruxolitinib) in California. Submit your request at least 2 weeks in advance via the Availity portal with complete documentation: confirmed diagnosis, hydroxyurea failure evidence (if applicable), baseline labs, and prescriber attestation

Renewing Qalsody (Tofersen) Coverage with Aetna CVS Health in Georgia: Timeline, Documentation & Bridge Options

Answer Box: Renewing Qalsody (Tofersen) with Aetna CVS Health in Georgia Aetna CVS Health requires annual renewal for Qalsody (tofersen) with updated clinical documentation showing continued medical necessity. Start renewal 2-4 weeks before expiration to avoid therapy gaps. Required: neurologist attestation of slowed ALS progression, current ALSFRS-R scores, confirmed SOD1

Do You Qualify for Opfolda (miglustat) Coverage by Aetna CVS Health in Washington? Decision Tree & Appeal Guide

Quick Answer: Opfolda Coverage by Aetna CVS Health in Washington Yes, you likely qualify if: You have confirmed late-onset Pompe disease (LOPD), are ≥18 years old and weigh >40 kg, have tried enzyme replacement therapy for ≥1 year without adequate improvement, and have a specialist prescribing Opfolda with Pombiliti

How to Get Opsumit (Macitentan) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide 2025

Answer Box: Getting Opsumit Covered in Virginia Opsumit (macitentan) requires prior authorization from Aetna CVS Health for pulmonary arterial hypertension (PAH). Key steps: 1) Have your PAH specialist document WHO Group 1 PAH diagnosis with NYHA/WHO functional class, 2) Complete step therapy requirements (typically ambrisentan or bosentan trial), and