Topic

Cigna

A collection of 1134 issues

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

Answer Box: Quick Path to Coverage Cigna requires prior authorization for Orkambi (lumacaftor/ivacaftor) in New Jersey. You'll need genetic testing showing F508del homozygosity, a CF specialist prescription, and documented medical necessity. If denied, you have 180 days to appeal internally, then can request New Jersey's

How to Get Hetlioz (Tasimelteon) Approved by Cigna in Florida: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Hetlioz Approved by Cigna in Florida Getting Hetlioz (tasimelteon) approved by Cigna in Florida requires completing their prior authorization process with comprehensive clinical documentation. You'll need specialist confirmation of Non-24-hour sleep-wake disorder or Smith-Magenis syndrome (ICD-10: G47.24/Q93.82), documented failure of step therapy

How to Get Hetlioz LQ Covered by Cigna in Florida: Prior Authorization Forms, Appeals, and Approval Scripts

Quick Answer: Getting Hetlioz LQ Approved by Cigna in Florida Hetlioz LQ requires prior authorization from Cigna for pediatric Smith-Magenis syndrome patients (ages 3-15). The fastest path: (1) Submit electronic PA via CoverMyMeds with genetic confirmation and sleep disturbance documentation, (2) Include evidence of failed melatonin/behavioral therapies, (3) Use

How to Get Hetlioz LQ (Tasimelteon Oral Suspension) Covered by Cigna in Pennsylvania: Prior Authorization Guide and Appeal Process

Answer Box: Getting Hetlioz LQ Covered by Cigna in Pennsylvania Eligibility: Hetlioz LQ requires prior authorization from Cigna for Smith-Magenis syndrome patients ages 3-15. Fastest path: Submit PA request through Express Scripts with confirmed SMS diagnosis, documented capsule trial failure, and sleep specialist consultation. First step today: Contact your prescriber

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

Quick Answer: Cabometyx (cabozantinib) requires prior authorization from Cigna in New Jersey, typically approved within 72 hours with complete documentation. Key requirements: FDA-approved diagnosis (RCC, HCC, or other labeled indications), documented prior therapy failures, and oncologist prescription. Submit via CoverMyMeds or Cigna provider portal. If denied, New Jersey's

How to Get Waylivra (Volanesorsen) Covered by Cigna in North Carolina: Appeals Guide and Policy Details

Quick Answer: Waylivra Coverage with Cigna in North Carolina Waylivra (volanesorsen) is not FDA-approved in the U.S., making Cigna coverage extremely unlikely through standard pathways. Nearly all initial requests are denied as "experimental" or "not medically necessary." Your best options: 1) Request FDA-approved Tryngolza (olezarsen)

How to Get Bylvay (odevixibat) Covered by Cigna in Ohio: Prior Authorization, Appeals, and State Protections

Quick Answer: Getting Bylvay (odevixibat) Covered by Cigna in Ohio Fastest path to approval: Your doctor submits prior authorization through Cigna/Express Scripts with detailed clinical documentation showing PFIC or Alagille syndrome diagnosis, failed alternative treatments, and medical necessity. If denied, file a written appeal within 180 days citing Ohio&

How to Get Mavenclad (Cladribine Tablets) Covered by Cigna in New York: A Complete Prior Authorization and Appeals Guide

Answer Box: Getting Mavenclad Covered by Cigna in New York Cigna requires prior authorization for Mavenclad (cladribine tablets) with strict step therapy requirements. You must document failure/intolerance of two other MS therapies OR one high-efficacy agent (Ocrevus, Tysabri, Kesimpta, Lemtrada, or Briumvi). Your neurologist submits the PA through Cigna&

Get Vimizim (Elosulfase Alfa) Covered by Cigna in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Your Path to Coverage Yes, Cigna covers Vimizim (elosulfase alfa) for MPS IVA in New Jersey, but prior authorization is mandatory. Your fastest path to approval: (1) Ensure your prescriber is a genetics or metabolic specialist, (2) Gather enzyme/genetic testing confirming MPS IVA diagnosis plus baseline functional

Do You Qualify for Elevidys Coverage by Cigna in Michigan? Complete Decision Tree & Appeal Guide

Quick Answer: Cigna requires prior authorization for Elevidys (delandistrogene moxeparvovec-rokl) with strict DMD genetic testing, anti-AAVrh74 antibody screening, and steroid protocol documentation. Most eligible patients need complete medical records, specialist letter, and submission through Cigna's specialty pharmacy network. If denied, Michigan patients have 180 days for internal appeals,