Topic

Aetna (CVS Health)

A collection of 1075 issues

The Requirements Checklist to Get Kuvan (Sapropterin) Covered by Aetna CVS Health in Michigan

Answer Box: Getting Kuvan Covered by Aetna CVS Health in Michigan Aetna CVS Health requires prior authorization for Kuvan (sapropterin) in PKU patients with phenylalanine levels ≥360 μmol/L (6 mg/dL) despite dietary management. You'll need confirmed PKU diagnosis, documented BH4 responsiveness (≥20% phenylalanine reduction), and specialist

Aetna CVS Health Coverage for Synagis (Palivizumab) in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Synagis Covered by Aetna CVS Health in Georgia Aetna CVS Health requires prior authorization for Synagis (palivizumab) with step therapy requiring Beyfortus first-line unless contraindicated. Coverage applies to high-risk infants during RSV season (November-March) with strict medical necessity criteria including prematurity <29 weeks, chronic lung disease,

How to Get Tysabri (natalizumab) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tysabri Covered by Aetna CVS Health in North Carolina Tysabri (natalizumab) requires prior authorization from Aetna CVS Health with mandatory TOUCH Prescribing Program enrollment, recent JCV antibody testing, and brain MRI documentation. Submit requests via phone (1-855-582-2025), fax (1-855-330-1716), or mail with complete medical records. If denied,

How to Get Defitelio (Defibrotide) Covered by Aetna CVS Health in Illinois: Complete Guide with Forms and Appeals

Answer Box: Getting Defitelio Covered by Aetna in Illinois Defitelio (defibrotide) requires prior authorization from Aetna CVS Health for severe hepatic veno-occlusive disease (VOD/SOS) with organ dysfunction post-HSCT. Submit PA through Aetna provider portal with complete transplant records, organ dysfunction evidence, and FDA indication match. If denied, file internal

How to Get Prolastin-C (Alpha1-Proteinase Inhibitor) Covered by Aetna CVS Health in Michigan: Complete Coding, Prior Authorization & Appeals Guide

Answer Box: Getting Prolastin-C Covered by Aetna CVS Health in Michigan Prolastin-C requires prior authorization from Aetna CVS Health with specific coding and documentation. Use ICD-10 code E88.01 (alpha-1 antitrypsin deficiency) with J43.9 (emphysema), HCPCS code J0256 (10mg units), and NDC 13533-0700-xx series. Submit PA forms to 888-267-3277

How to Get Filspari (Sparsentan) Covered by Aetna CVS Health in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Filspari Coverage in Texas To get Filspari (sparsentan) covered by Aetna CVS Health in Texas: Your nephrologist must submit a prior authorization showing biopsy-confirmed primary IgA nephropathy, UPCR ≥0.8 g/g, and 3+ months of failed ACE/ARB therapy. Complete REMS enrollment at filsparirems.

How to Get Keppra (Levetiracetam) Covered by Aetna CVS Health in California: Complete Prior Authorization Guide

Answer Box: Quick Path to Approval Keppra (levetiracetam) typically doesn't require prior authorization from Aetna CVS Health in California for generic versions. However, brand-name Keppra may need step therapy approval after trying generic levetiracetam first. If denied, California members can file a free Independent Medical Review (IMR) through

Do You Qualify for Orfadin (Nitisinone) Coverage by Aetna CVS Health in New York? Decision Tree & Next Steps

Answer Box: Your Path to Orfadin Coverage Aetna CVS Health requires prior authorization for Orfadin (nitisinone) in New York, with approval based on confirmed hereditary tyrosinemia type 1 (HT-1) diagnosis, elevated succinylacetone levels (>2 μmol/L), and dietary management plan. Standard decisions take 72 hours; expedited cases 24 hours.

How to Get Cystadane (Betaine Anhydrous) Covered by Aetna CVS Health in New York: Prior Authorization Guide with Appeal Scripts

Answer Box: Getting Cystadane (Betaine Anhydrous) Covered by Aetna CVS Health in New York Cystadane requires prior authorization from Aetna CVS Health in New York, with 12-month approvals typically granted when you provide genetic confirmation of homocystinuria, documented vitamin therapy trials, and current lab values. Submit renewals via Availity provider

How to Get Sumavel DosePro (Sumatriptan Injection, Needle-Free) Covered by Aetna CVS Health in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Sumavel DosePro Covered by Aetna CVS Health in Michigan Sumavel DosePro (needle-free sumatriptan injection) requires prior authorization from Aetna CVS Health, with approval typically granted after documenting failure of at least two oral triptans for migraine or cluster headache treatment. Michigan patients have strong appeal rights through