Topic

Cigna

A collection of 1278 issues

How to Get Raxone (idebenone) Covered by Cigna in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Raxone (idebenone) Covered by Cigna in New Jersey Raxone (idebenone) requires prior authorization from Cigna and faces coverage challenges as a non-FDA approved medication. Your physician must submit a formulary exception request demonstrating medical necessity for LHON treatment. If denied, New Jersey's IHCAP external review

How to Get Translarna (Ataluren) Covered by Cigna in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Translarna Coverage Translarna (ataluren) requires prior authorization from Cigna and is non-formulary, needing a formulary exception for nonsense mutation Duchenne muscular dystrophy (DMD). Your neuromuscular specialist must submit comprehensive documentation via the EviCore portal, including genetic confirmation of nonsense mutation and proof of ambulatory status.

Cigna's Coverage Criteria for Pombiliti (cipaglucosidase alfa-atga) in Michigan: What Counts as "Medically Necessary"?

Answer Box: Getting Pombiliti Covered by Cigna in Michigan Cigna requires prior authorization for Pombiliti + Opfolda combination therapy for late-onset Pompe disease patients ≥18 years, weighing >40 kg, who show no improvement in forced vital capacity (FVC) or 6-minute walk test after ≥1 year on Lumizyme or Nexviazyme. Submit

How to Get Eloctate Approved by Cigna in Florida: Timeline, Forms & Appeal Success Strategies

Quick Answer: Getting Eloctate Approved by Cigna in Florida Eloctate (efmoroctocog alfa) requires prior authorization from Cigna in Florida, typically processed within 72 hours for standard requests or 24 hours for urgent cases. Your doctor submits via CoverMyMeds or calls 1-800-882-4462. Key requirements: hemophilia A diagnosis (ICD-10: D66), prescription by

How Long Does It Take to Get Amvuttra (vutrisiran) Approved by Cigna in California? Complete Timeline Guide

Answer Box: Fastest Path to Amvuttra (vutrisiran) Approval Getting Amvuttra (vutrisiran) covered by Cigna in California typically takes 72 hours for complete submissions, or 24 hours for urgent cases. You'll need genetic testing confirming a TTR pathogenic variant, documented polyneuropathy (hATTR-PN) or cardiomyopathy (ATTR-CM), and may face step

How to Get Ofev (nintedanib) Covered by Cigna in Michigan: ICD-10 Codes, Prior Authorization, and Appeal Scripts

Answer Box To get Ofev (nintedanib) covered by Cigna in Michigan: Your pulmonologist must submit prior authorization using Michigan's standardized PA form (FIS 2288) with ICD-10 code J84.112 (IPF) or M34.81 (SSc-ILD), HRCT confirming fibrosis, and PFTs showing FVC ≥40% predicted. Cigna has 15 days to

How to Get Cimzia (Certolizumab Pegol) Covered by Cigna in Washington: Complete PA Guide and Appeal Process

Answer Box: Getting Cimzia Covered by Cigna in Washington Cigna requires prior authorization for Cimzia (certolizumab pegol) across all FDA-approved conditions. In Washington, your fastest path to approval involves: (1) Having your specialist submit the PA form with documented failure of conventional therapy and preferred TNF inhibitors, plus required TB/

Lowering Out-of-Pocket for Elzonris (Tagraxofusp-erzs) with Cigna in Ohio: Complete Copay, Tiering & Financial Assistance Guide

Answer Box: Getting Elzonris Covered by Cigna in Ohio Elzonris (tagraxofusp-erzs) requires prior authorization from Cigna and is placed in Tier 4 (specialty tier) with high out-of-pocket costs. To minimize expenses: (1) Apply for Stemline's copay card (up to $25,000/year coverage) and patient assistance program (free

How to Get Kymriah (tisagenlecleucel) Covered by Cigna in Illinois: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Kymriah Covered by Cigna in Illinois Cigna covers Kymriah (tisagenlecleucel) for FDA-approved indications with prior authorization through certified CAR-T centers. Most common path: 1) Submit PA with medical necessity letter documenting CD19+ disease and prior therapy failures, 2) If denied, request peer-to-peer review immediately, 3) File internal

How to Get Advate (Octocog Alfa) Covered by Cigna in Georgia: Appeals, Forms & State Protections

Answer Box: Getting Advate (Octocog Alfa) Covered by Cigna in Georgia Fastest path to approval: Submit prior authorization through Cigna's Express Scripts portal with hemophilia A diagnosis, factor VIII levels, inhibitor testing, and weight-based dosing rationale. If denied, Georgia's step therapy override law (O.C.G.