Topic

Enhertu (fam-trastuzumab deruxtecan-nxki)

A collection of 34 issues

Coding That Helps Get Enhertu (fam-trastuzumab deruxtecan-nxki) Approved with Humana in California: ICD-10, J-Code, and NDC Guide

Quick Answer: Coding for Enhertu (fam-trastuzumab deruxtecan-nxki) Approval Getting Enhertu covered by Humana in California requires precise coding: ICD-10 Z17.31 (HER2-positive status) paired with your cancer diagnosis (C50.-, C16.-, C34.-), J-code J9358 (1 mg units), and NDC 65597-0406-01. Submit prior authorization through Humana's Availity

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Aetna CVS Health in Florida: Complete Prior Authorization Guide and Appeals Process

Answer Box: Getting Enhertu Covered by Aetna CVS Health in Florida Enhertu (fam-trastuzumab deruxtecan-nxki) requires prior authorization from Aetna CVS Health for all FDA-approved indications. The fastest path to approval: (1) Submit Aetna's Enhertu precertification form (GR-69531 5-24) with HER2 testing results and prior therapy documentation, (2) Include

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Enhertu Covered by BCBS in New York Enhertu (fam-trastuzumab deruxtecan-nxki) requires prior authorization from Blue Cross Blue Shield plans in New York for HER2-positive breast cancer, NSCLC, and gastric cancer. Key requirements include documented HER2 status (IHC 3+ or ISH amplified), prior trastuzumab-based therapy failure, and NCCN

The Requirements Checklist to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Blue Cross Blue Shield in New Jersey: Forms, Appeals, and PA Guide

Answer Box: Getting Enhertu Covered by Blue Cross Blue Shield in New Jersey Eligibility: HER2-positive unresectable/metastatic breast cancer or other FDA-approved HER2-expressing tumors after prior anti-HER2 therapy. Fastest path: Submit prior authorization via Horizon BCBS Provider Portal or MagellanRx (1-800-424-4508) with HER2 pathology report, treatment history, and monitoring plan.

How Long Does It Take to Get Enhertu Approved by UnitedHealthcare in New York? Timeline & Milestones

Answer Box: Enhertu Approval Timeline with UnitedHealthcare in New York Standard timeline: 5-15 business days for non-urgent requests, 24-72 hours for expedited oncology cases. Fastest path: Submit complete PA through UHC Provider Portal with HER2 biomarker results, prior therapy documentation, and oncologist attestation. Start today: Have your oncologist verify Enhertu

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Humana in Michigan: Prior Authorization Guide and Appeals Process

Answer Box: Getting Enhertu Covered by Humana in Michigan Enhertu (fam-trastuzumab deruxtecan-nxki) requires prior authorization from Humana Medicare Advantage plans due to its high cost (~$2,440 per 100mg vial) and specialized oncology use. To get coverage in Michigan: 1. Submit prior authorization via Humana's provider portal with

How to Get Enhertu Covered by Blue Cross Blue Shield in Georgia: Complete Guide to Prior Authorization, Appeals, and Forms

Answer Box: Getting Enhertu Approved in Georgia Blue Cross Blue Shield of Georgia requires prior authorization for Enhertu® (fam-trastuzumab deruxtecan-nxki) with mandatory HER2 testing documentation. Submit your PA request through the Availity provider portal or call member services at the number on your ID card. If denied, you have 180

Lowering Out-of-Pocket Costs for Enhertu with UnitedHealthcare in North Carolina: Copay Cards, Tiering Appeals, and Financial Assistance

Answer Box: Enhertu (fam-trastuzumab deruxtecan-nxki) costs $150,000+ annually but UnitedHealthcare commercial patients can reduce out-of-pocket to $0 drug cost plus $100/infusion using the ENHERTU4U copay program. Submit prior authorization via UnitedHealthcare Provider Portal with HER2-positive pathology results and prior therapy documentation. If denied, appeal internally within 180 days,

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Cigna in Washington: Appeals Guide with State Protections

Answer Box: Getting Enhertu Covered by Cigna in Washington Eligibility: Enhertu (fam-trastuzumab deruxtecan-nxki) requires prior authorization through Cigna's Express Scripts/Accredo for HER2-positive cancers. Fastest path: Submit PA with HER2+ test results, prior therapy failures, and oncologist's medical necessity letter. First step today: Call Cigna (number

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Cigna in Pennsylvania: Complete Appeals Guide with Forms & Timelines

Answer Box: Getting Enhertu Covered by Cigna in Pennsylvania Fastest path to approval: Submit prior authorization through Cigna's provider portal with documented HER2-positive status, prior therapy failures, and NCCN guideline support. If denied, request peer-to-peer review within 7-14 days, then file internal appeals within 180 days. Pennsylvania residents