Topic

Cigna

A collection of 611 issues

How to Get Joenja (leniolisib) Covered by Cigna in Virginia: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Joenja (leniolisib) Covered by Cigna in Virginia Cigna requires prior authorization for Joenja (leniolisib) with strict criteria: genetic confirmation of APDS via CLIA-certified testing, specialist prescription (immunologist/geneticist), patient age ≥12 years and weight ≥45 kg. Submit electronically via CoverMyMeds with complete documentation. If denied, Virginia residents

How to Get Besponsa (Inotuzumab Ozogamicin) Covered by Cigna in California: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Besponsa Covered by Cigna in California Besponsa (inotuzumab ozogamicin) requires prior authorization from Cigna in California. Your fastest path to approval: 1) Have your oncologist submit a PA request through Cigna's provider portal with complete CD22+ B-cell ALL documentation, 2) If denied, file an internal

How to Get Filsuvez (Birch Triterpenes Topical Gel) Covered by Cigna in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Filsuvez Covered by Cigna in Washington Eligibility: Cigna covers Filsuvez for dystrophic or junctional epidermolysis bullosa patients ≥6 months old with confirmed genetic diagnosis and clean wounds 10-50 cm² that are 21+ days but <9 months old. Fastest Path: Have your dermatologist submit prior authorization through

Lowering Out-of-Pocket for Voydeya (danicopan) with Cigna in New York: Copay, Tiering & Assistance

Answer Box: Quick Path to Lower Voydeya Costs Voydeya (danicopan) is a Tier 4 specialty drug on Cigna's formulary requiring prior authorization and costing 25-33% coinsurance or high copays. To reduce costs: (1) Apply for Alexion OneSource copay assistance (up to $15,000/year for commercial insurance), (2)

How to Get Opzelura (Ruxolitinib Cream) Covered by Cigna in North Carolina: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Opzelura Covered by Cigna in North Carolina Cigna requires prior authorization for Opzelura (ruxolitinib cream) with mandatory step therapy in North Carolina. You must document failure of topical steroids (28+ days) OR calcineurin inhibitors (12+ weeks) before approval. Submit through your dermatologist via Cigna's provider

Myths vs. Facts: Getting Kalydeco (ivacaftor) Covered by Cigna in California

Quick Answer: To get Kalydeco (ivacaftor) covered by Cigna in California, you need prior authorization with CFTR genetic testing documentation and a CF specialist's prescription. If denied, file an internal appeal within 180 days, then request California's Independent Medical Review (IMR) through DMHC. Success rates for

How to Get Dojolvi (triheptanoin) Covered by Cigna in California: Complete PA Requirements and Appeals Guide

Quick Answer: Getting Dojolvi (triheptanoin) Covered by Cigna in California Cigna requires prior authorization for Dojolvi (triheptanoin) with molecular confirmation of LC-FAOD diagnosis, specialist prescribing, and documented MCT oil discontinuation. Submit through Express Scripts/Accredo with genetic testing results, treatment history, and medical necessity letter. If denied, file internal appeal

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