Topic

Cigna

A collection of 605 issues

How to Get Oxlumo (Lumasiran) Covered by Cigna in Michigan: Complete Prior Authorization and Appeals Guide

Quick Answer: To get Oxlumo (lumasiran) covered by Cigna in Michigan, you'll need prior authorization with confirmed PH1 diagnosis, genetic testing (AGXT), nephrologist prescription, and documented urinary oxalate levels. Submit via CoverMyMeds or Cigna portal. If denied, use Michigan's 180-day internal appeal window, then DIFS external

Cigna's Coverage Criteria for Qinlock (Ripretinib) in New York: What Counts as "Medically Necessary"?

Quick Answer: Getting Qinlock (Ripretinib) Covered by Cigna in New York Cigna requires prior authorization for Qinlock (ripretinib) and enforces strict step therapy: you must have tried and failed imatinib, sunitinib, and regorafenib first. Medical necessity requires documented GIST diagnosis, progression after these three therapies, and oncologist prescription. First step

Getting Orkambi (lumacaftor/ivacaftor) Covered by Cigna in North Carolina: Complete Guide to Prior Authorization, Appeals, and Templates

Quick Answer: Getting Orkambi Covered by Cigna in North Carolina Cigna requires prior authorization for Orkambi (lumacaftor/ivacaftor) with proof of homozygous F508del mutation and CF specialist prescription. If denied, you have 180 days for internal appeals, then can request external review through North Carolina's Smart NC program.

How to Get Skyrizi (Risankizumab) Covered by Cigna in North Carolina: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Skyrizi (risankizumab) covered by Cigna in North Carolina requires prior authorization through Express Scripts/Accredo. Submit via CoverMyMeds portal with clinical documentation showing disease severity (PASI ≥10 or BSA ≥10% for psoriasis) and prior systemic therapy failures. If denied, appeal through Cigna's internal process, then

How to Get Ozempic or Mounjaro Covered by Cigna in Washington: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Ozempic or Mounjaro Covered by Cigna in Washington Eligibility: Cigna covers Ozempic (semaglutide) and Mounjaro (tirzepatide) for Type 2 diabetes with prior authorization. Coverage for weight loss varies by plan. Fastest path to approval: 1. Your doctor submits a prior authorization request through CoverMyMeds or calls 1-800-882-4462

How to Get Xenpozyme (olipudase alfa-rpcp) Covered by Cigna in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Xenpozyme Covered by Cigna in Washington Xenpozyme (olipudase alfa-rpcp) requires prior authorization from Cigna for ASMD (Niemann-Pick types A/B). Your fastest path: (1) Confirm genetic diagnosis with SMPD1 variants and enzyme deficiency <10% normal, (2) Have your specialist submit PA with weight-based dosing plan via

The Requirements Checklist to Get Aldurazyme (Laronidase) Covered by Cigna in Texas

Quick Answer: Getting Aldurazyme Covered by Cigna in Texas Eligibility: Patients with confirmed mucopolysaccharidosis I (MPS I) via genetic/biochemical testing. Fastest approval path: Submit complete prior authorization with genetic confirmation, baseline assessments, and specialist attestation through Cigna's provider portal or Express Scripts/Accredo. First step today: Contact

How to Get Qinlock (ripretinib) Covered by Cigna in Texas: Prior Authorization Guide & Appeal Scripts

Quick Answer: Getting Qinlock (ripretinib) Covered by Cigna in Texas Cigna covers Qinlock (ripretinib) for fourth-line GIST treatment with prior authorization. You must document failure of three prior tyrosine kinase inhibitors: imatinib, sunitinib, and regorafenib. First step: Have your oncologist submit a prior authorization request with complete treatment history. If

Getting Brineura (Cerliponase Alfa) Covered by Cigna in Ohio: PA Forms, Appeals, and Cost Assistance

Answer Box: Getting Brineura Covered by Cigna in Ohio Brineura (cerliponase alfa) requires prior authorization from Cigna with confirmed CLN2 diagnosis, specialist involvement, and administration at an approved infusion center. The fastest path: (1) Gather genetic testing and TPP1 enzyme results confirming CLN2 disease, (2) Have your pediatric neurologist submit

How to Get Jynarque (Tolvaptan) Covered by Cigna in Michigan: Complete PA Guide with Forms and Appeal Scripts

Answer Box: Getting Jynarque Covered by Cigna in Michigan Jynarque (tolvaptan) requires prior authorization through Cigna and is typically covered as a Tier 4 specialty medication with step therapy requirements. To get approved in Michigan: 1. Document rapid ADPKD progression (Mayo Class 1C-1E or eGFR decline ≥3 mL/min/1.