Topic

Exondys 51 (eteplirsen)

A collection of 28 issues

How to Get Exondys 51 (Eteplirsen) Covered by Cigna in Texas: Complete Prior Authorization Guide

Answer Box: Fastest Path to Exondys 51 Coverage To get Exondys 51 (eteplirsen) covered by Cigna in Texas: Submit prior authorization through CoverMyMeds or fax to (855) 840-1678 with genetic testing confirming exon 51-skipping DMD mutation, 6-minute walk test ≥180 meters, and prescription from a neuromuscular specialist. If denied, you

How to Get Exondys 51 (Eteplirsen) Covered by Aetna CVS Health in Virginia: Complete Coding, Billing, and Appeals Guide

Answer Box: Getting Exondys 51 Covered by Aetna CVS Health in Virginia Exondys 51 (eteplirsen) requires prior authorization from Aetna CVS Health with specific coding and documentation. Use ICD-10 code G71.01 for Duchenne muscular dystrophy, HCPCS code J1428 for billing (10 mg units), and submit genetic testing confirming exon

Blue Cross Blue Shield Ohio's Coverage Criteria for Exondys 51: What Counts as "Medically Necessary"?

Answer Box Blue Cross Blue Shield of Ohio (Anthem) requires prior authorization for Exondys 51 (eteplirsen) with specific medical necessity criteria: confirmed DMD with exon 51-amenable genetic mutation, stable corticosteroid therapy ≥6 months, meaningful motor function, and neurologist prescriber. Submit PA via Anthem provider portal with genetic test results, baseline

How to Get Exondys 51 (Eteplirsen) Covered by Aetna CVS Health in California: Prior Authorization Guide and Appeals Process

Answer Box: Fast Track to Approval To get Exondys 51 (eteplirsen) covered by Aetna CVS Health in California: Submit prior authorization with genetic testing confirming exon 51 amenable DMD mutation, specialist prescription, baseline functional assessments (6-minute walk test ≥300m), and corticosteroid trial documentation. If denied, file internal appeal within 21

Myths vs. Facts: Getting Exondys 51 (eteplirsen) Covered by Humana in Florida

Answer Box: To get Exondys 51 (eteplirsen) covered by Humana in Florida, you need: 1) Genetic testing confirming an exon 51-amenable DMD mutation, 2) A neuromuscular specialist's prescription with medical necessity documentation, and 3) Prior authorization submission via Humana's provider portal. Standard PA decisions take 72

How to Get Exondys 51 (Eteplirsen) Covered by UnitedHealthcare in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Exondys 51 Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Exondys 51 (eteplirsen) with specific criteria: confirmed DMD with exon 51-amenable mutation, ambulatory status, specialist prescriber, and baseline testing. First step: Contact a DMD specialist at Mount Sinai or NYU Langone to order genetic

How to Get Exondys 51 (eteplirsen) Covered by Aetna (CVS Health) in Washington: Appeals, Timelines & Templates

Answer Box: Your Fastest Path to Approval Getting Exondys 51 (eteplirsen) covered by Aetna (CVS Health) in Washington requires genetic testing proving exon 51-amenable DMD mutation, specialist prescriber, and functional documentation. Submit prior authorization with complete genetic report, 6-minute walk test results, and neuromuscular specialist letter. If denied, Washington law

Renewing Exondys 51 (Eteplirsen) Approval with Blue Cross Blue Shield in Georgia: Timeline, Documentation & Appeal Guide

Answer Box: Renewing Exondys 51 Coverage in Georgia Start your renewal process 90 days before your current authorization expires. Blue Cross Blue Shield Georgia typically requires updated clinical assessments, genetic confirmation, and specialist documentation for Exondys 51 (eteplirsen) renewals. If denied, you have 60 days to file an internal appeal,

Myths vs. Facts: Getting Exondys 51 (Eteplirsen) Covered by UnitedHealthcare in Illinois - Appeals Guide

Answer Box: Fast Track to Exondys 51 Coverage in Illinois Eligibility: Patients with confirmed DMD and exon 51-amenable mutations can get UnitedHealthcare coverage through proper documentation. Fastest path: Submit prior authorization through UnitedHealthcare's electronic portal with genetic testing, neurologist evaluation, and functional assessments. Start today: Contact your neurologist

How to Get Exondys 51 (Eteplirsen) Covered by UnitedHealthcare in Ohio: Complete Prior Authorization and Appeals Guide 2025

Answer Box: Getting Exondys 51 Covered by UnitedHealthcare in Ohio Quick Path to Approval: Exondys 51 (eteplirsen) requires prior authorization through UnitedHealthcare's OptumRx. You'll need genetic testing confirming exon 51 amenable DMD mutation, ambulatory status without assistive devices, and either NSAA score >17 or Time