Topic

Exondys 51 (eteplirsen)

A collection of 28 issues

Myths vs. Facts: Getting Exondys 51 (Eteplirsen) Covered by Cigna in Florida

Answer Box: The Real Path to Exondys 51 Coverage Most Cigna plans in Florida cover Exondys 51 with proper documentation. You need: confirmed genetic testing showing exon 51-amenable DMD mutation, specialist prescription, baseline cardiac/renal function tests, and ambulatory status proof (6-minute walk test ≥180 meters). Fastest approval path: Submit

How to Get Exondys 51 (eteplirsen) Covered by Cigna in Virginia: Appeals Guide, Forms & Timelines

Quick Answer: To get Exondys 51 (eteplirsen) covered by Cigna in Virginia, you need genetic testing confirming an exon 51-amenable DMD mutation, a neuromuscular specialist's prescription, and documentation of ambulatory status with cardiac/pulmonary baselines. Submit prior authorization through Accredo Specialty Pharmacy. If denied, appeal within 180 days

Myths vs. Facts: Getting Exondys 51 (Eteplirsen) Covered by Humana in California

Quick Answer: Exondys 51 Coverage by Humana in California Getting Exondys 51 (eteplirsen) covered by Humana requires prior authorization with strict genetic documentation—specifically proof of a DMD mutation amenable to exon 51 skipping. The fastest path: have your neurologist submit genetic test results, baseline functional assessments, and corticosteroid therapy

Getting Exondys 51 (Eteplirsen) Covered by UnitedHealthcare in Florida: Coding, Appeals, and Success Strategies

Answer Box: Quick Path to Coverage To get Exondys 51 (eteplirsen) covered by UnitedHealthcare in Florida: Submit prior authorization with genetic testing confirming exon 51-amenable DMD mutation (ICD-10: G71.01), neurologist evaluation, and stable corticosteroid documentation. Use HCPCS J-code J1428 for billing (1 unit = 10mg). If denied, file internal appeal

How to Get Exondys 51 (Eteplirsen) Covered by Cigna in California: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Exondys 51 Covered by Cigna in California Quick Path to Approval: Cigna requires genetic testing proving exon 51 amenability, specialist prescriber, and prior authorization through Express Scripts/Accredo. If denied, file internal appeal within 180 days, then request California Independent Medical Review (IMR) through DMHC. Success rates

How to Get Exondys 51 (Eteplirsen) Covered by Cigna in North Carolina: Appeals Guide, Forms & Timelines

Answer Box: Getting Exondys 51 Covered by Cigna in North Carolina Exondys 51 (eteplirsen) requires prior authorization from Cigna with genetic testing proving exon 51 skipping amenability. Submit PA request via fax to (855) 840-1678 with genetic test results, specialist prescription, and clinical documentation. If denied, you have 180 days

Getting Exondys 51 (Eteplirsen) Covered by Blue Cross Blue Shield in New York: Complete PA Guide

Answer Box: Quick Path to Coverage Exondys 51 (eteplirsen) requires prior authorization from Blue Cross Blue Shield in New York. Your fastest path: 1) Confirm genetic testing shows DMD with exon 51 mutation amenable to skipping, 2) Have a pediatric neurologist or neuromuscular specialist complete the BCBS Medical Authorization Request

Renewing Exondys 51 (Eteplirsen) Approval with UnitedHealthcare in North Carolina: 2025 Requirements & Timeline

Answer Box: Renewing Your Exondys 51 Coverage Quick Answer: UnitedHealthcare requires annual renewal of Exondys 51 (eteplirsen) prior authorization with updated clinical documentation. Start the renewal process 60-90 days before your current authorization expires. You'll need: neurologist evaluation showing continued benefit, updated cardiac/renal function tests, and proof