Topic

Aetna (CVS Health)

A collection of 1288 issues

If Garadacimab Isn't Approved by Aetna in Illinois: HAE Prophylaxis Alternatives & Exception Paths

Answer Box: Getting HAE Prophylaxis Coverage When Garadacimab Is Denied If Aetna denies Garadacimab (Andembry) in Illinois, you have strong alternatives and appeal rights. First step: Check if lanadelumab (Takhzyro) or berotralstat (Orladeyo) are formulary-preferred—these often serve as step therapy requirements. Fastest path: Submit prior authorization for the preferred
5 min read

How to Get Humate-P (Antihemophilic Factor/vWF Complex) Covered by Aetna CVS Health in Michigan: Complete Appeals Guide

Answer Box: Fast Track to Humate-P Coverage Humate-P requires prior authorization from Aetna CVS Health in Michigan. Submit via the Aetna provider portal with hematologist consultation, VWF labs, and desmopressin trial documentation (if applicable). Standard decisions take 7-14 days; expedited reviews complete within 72 hours for urgent cases. If denied,
6 min read

How Long Does It Take to Get Orfadin (nitisinone) Approved by Aetna (CVS Health) in Washington? Timeline & Appeals

Answer Box: Timeline Overview Aetna (CVS Health) typically approves Orfadin (nitisinone) prior authorization requests within 72 hours for standard cases and 24 hours for expedited reviews in Washington. Over 95% of eligible requests are approved within 24 hours when complete documentation is submitted. Key requirements include confirmed hereditary tyrosinemia type
5 min read

Work With Your Doctor to Get Synagis (Palivizumab) Approved by Aetna CVS Health in Ohio: Complete Provider Collaboration Guide

Answer Box: Getting Synagis Approved in Ohio Aetna CVS Health requires prior authorization for Synagis (palivizumab) via their precertification form, approving only high-risk infants when Beyfortus is contraindicated or unavailable. Your pediatrician must document specific criteria (prematurity <29 weeks GA, chronic lung disease, or hemodynamically significant heart disease) and
6 min read

How to Get Revcovi (elapegademase) Covered by Aetna CVS Health in Virginia: Complete PA Guide with Forms and Appeal Steps

Answer Box: Getting Revcovi Covered by Aetna CVS Health in Virginia Revcovi (elapegademase) requires prior authorization from Aetna CVS Health but is covered on the specialty tier for confirmed ADA-SCID cases. Submit a complete PA packet including genetic/enzyme testing, specialist documentation, and transplant failure evidence through the Aetna provider
6 min read