Topic

Darzalex / Darzalex Faspro (daratumumab)

A collection of 30 issues

UnitedHealthcare's Coverage Criteria for Darzalex (Daratumumab) in North Carolina: Complete Medical Necessity Guide

Answer Box: Getting Darzalex Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Darzalex (daratumumab) with specific medical necessity criteria: confirmed multiple myeloma diagnosis, appropriate treatment line documentation, and FDA-approved or NCCN guideline-supported regimens. Submit PA requests through the UnitedHealthcare Provider Portal with complete clinical documentation. If denied,

Blue Cross Blue Shield Virginia's Coverage Criteria for Darzalex/Darzalex Faspro: What Counts as "Medically Necessary"?

Answer Box: Getting Darzalex Covered by Blue Cross Blue Shield in Virginia Blue Cross Blue Shield Virginia requires prior authorization for daratumumab (Darzalex/Darzalex Faspro) with specific medical necessity criteria. To get approved: (1) Have your oncologist document FDA-approved diagnosis (multiple myeloma or AL amyloidosis) with ICD-10 codes, (2) Submit

How to Get Darzalex/Darzalex Faspro (Daratumumab) Covered by Cigna in California: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Darzalex Covered by Cigna in California Darzalex/Darzalex Faspro requires prior authorization from Cigna, but approval is achievable with proper documentation. In California, you have strong appeal rights through the DMHC's Independent Medical Review process if initially denied. Fastest path to approval: 1. Submit Cigna&

How to Get Darzalex/Darzalex Faspro (Daratumumab) Approved by Aetna in Georgia: Prior Authorization Guide and Appeals Process

Quick Answer: Getting Darzalex/Darzalex Faspro Covered by Aetna in Georgia Aetna requires prior authorization for Darzalex (daratumumab) in Georgia. Your fastest path to approval: Have your oncologist complete Aetna's 2024 Darzalex precertification form with complete multiple myeloma documentation, including prior therapies tried and failed. Submit via fax

Get Darzalex (Daratumumab) Covered by Cigna in Ohio: Complete Prior Authorization & Appeal Guide

Answer Box: Quick Path to Coverage Yes, Cigna covers Darzalex (daratumumab) in Ohio, but requires prior authorization and step therapy. Your fastest path: 1) Have your oncologist submit Cigna's PA form with documentation of failed prior therapy (like lenalidomide or bortezomib), 2) If denied, file internal appeal within

If Darzalex Isn't Covered by Humana in Pennsylvania: Formulary Alternatives & Exception Strategies

Quick Answer: Alternatives When Darzalex Isn't Covered If Humana denies Darzalex (daratumumab) coverage in Pennsylvania, you typically have three paths: try covered alternatives like Sarclisa (isatuximab), lenalidomide (Revlimid), or carfilzomib (Kyprolis); request a formulary exception with strong clinical justification; or appeal through Pennsylvania's external review process.

How to Get Darzalex (Daratumumab) Covered by Aetna CVS Health in California: Complete Prior Authorization Guide

Quick Answer: Getting Darzalex Covered by Aetna CVS Health in California Darzalex requires prior authorization from Aetna CVS Health. The fastest path: (1) Submit complete PA forms with documentation showing bortezomib failure/intolerance, (2) Include detailed medical necessity letter with ICD-10 codes and treatment history, (3) If denied, file internal

How to Get Darzalex / Darzalex Faspro (daratumumab) Covered by Humana in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Darzalex / Darzalex Faspro Covered by Humana in California Yes, Humana covers both Darzalex (IV) and Darzalex Faspro (subcutaneous) daratumumab in California, but prior authorization is required. Your fastest path to approval: 1) Have your oncologist submit a complete PA request through Humana's provider portal with

How to Get Darzalex / Darzalex Faspro (daratumumab) Covered by Aetna (CVS Health) in Virginia: Complete Guide to Prior Authorization, Appeals, and State Protections

Answer Box: Your Fastest Path to Coverage Getting Darzalex / Darzalex Faspro (daratumumab) covered by Aetna (CVS Health) in Virginia requires prior authorization and often step therapy compliance. Your oncologist must document that bortezomib (the preferred agent) has failed or is contraindicated. Submit Aetna's precertification form via phone (1-866-752-7021)

Lowering Out-of-Pocket Costs for Darzalex with Humana in Texas: Copay Cards, Assistance Programs & Tier Exceptions

Answer Box: Getting Darzalex Covered by Humana in Texas Humana requires prior authorization for Darzalex (daratumumab) and places it on specialty tier (typically 20-33% coinsurance). Your fastest path: Have your oncologist submit PA documentation immediately, apply for Janssen's copay card if you have commercial insurance (not Medicare), and