Topic

Florida

A collection of 48 issues

How to Get Jakafi (Ruxolitinib) Covered by Cigna in Florida: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Jakafi (Ruxolitinib) Covered by Cigna in Florida Jakafi (ruxolitinib) requires prior authorization through Cigna/Express Scripts for myelofibrosis and polycythemia vera. In Florida, you have 180 days to appeal denials internally, then 4 months for external review through the Florida Department of Financial Services. First step today:

How to Get Chenodal (chenodiol) Covered by UnitedHealthcare in Florida: Prior Authorization Forms, Appeals, and Step-by-Step Guide

Answer Box: Getting Chenodal Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Chenodial (chenodiol) and places it on a non-preferred specialty tier. Coverage is limited to cerebrotendinous xanthomatosis (CTX) with genetic confirmation—not gallstone dissolution. First step: Have your specialist submit a PA request through the UnitedHealthcare Provider

How to Get Turalio (Pexidartinib) Covered by Blue Cross Blue Shield in Florida: Complete Appeals Guide with Templates

Answer Box: Quick Path to Turalio Coverage To get Turalio (pexidartinib) covered by Blue Cross Blue Shield in Florida: 1) Ensure complete REMS enrollment (prescriber, patient, pharmacy), 2) Submit prior authorization with TGCT diagnosis documentation and surgical contraindications, 3) If denied, file internal appeal within 180 days with medical necessity

Myths vs. Facts: Getting Rystiggo (Rozanolixizumab-Noli) Covered by Humana in Florida

Answer Box: Rystiggo Coverage by Humana in Florida Getting Rystiggo (rozanolixizumab-noli) covered by Humana in Florida requires prior authorization with documented AChR or MuSK antibody-positive generalized myasthenia gravis and failure of standard therapies. The fastest path: ensure your neurologist submits complete PA documentation showing inadequate response to acetylcholinesterase inhibitors, steroids,

How to Get Hetlioz (Tasimelteon) Covered by UnitedHealthcare in Florida: Complete PA Guide and Appeals Process

Quick Answer: Getting Hetlioz Covered by UnitedHealthcare in Florida Hetlioz requires prior authorization from UnitedHealthcare through OptumRx. The fastest path to approval: (1) Confirm your diagnosis qualifies—Non-24-hour sleep-wake disorder in totally blind adults or Smith-Magenis syndrome sleep disturbances, (2) Document failed melatonin therapy or contraindications, and (3) Have a

Coding That Helps Get Hetlioz LQ (Tasimelteon) Approved by Humana in Florida: ICD-10, NDC, and Billing Guide

Answer Box: Getting Hetlioz LQ Covered by Humana in Florida Hetlioz LQ (tasimelteon oral suspension) requires prior authorization from Humana Medicare Part D plans in Florida. The fastest path to approval: 1) Use ICD-10 code Q93.82 for Smith-Magenis syndrome with sleep disturbance codes (G47.0 for insomnia), 2) Submit

How to Renew Epidiolex (Cannabidiol) Approval with Cigna in Florida: 2024 Requirements and Timeline

Answer Box: Renewing Epidiolex Approval with Cigna in Florida Cigna requires annual prior authorization renewal for Epidiolex in Florida, typically 30-60 days before your current approval expires. Your neurologist must submit documentation showing continued clinical benefit (≥30-50% seizure reduction from baseline), current diagnosis confirmation, and hepatic monitoring results. Cigna renders

How Long Does It Take to Get Advate (Octocog Alfa) Approved by UnitedHealthcare in Florida? Complete Timeline Guide

Quick Answer: Advate Approval Timeline for UnitedHealthcare in Florida Standard timeline: 5-14 days for routine prior authorization; 72 hours or less for urgent bleeding episodes. UnitedHealthcare considers Advate a preferred standard half-life factor VIII product, making approval more straightforward than extended half-life alternatives. Your fastest path: Have your hematologist submit

How to Get Juxtapid (Lomitapide) Covered by Florida Blue Cross Blue Shield: PA Forms, Appeals & Success Tips

Answer Box: Getting Juxtapid Covered by Florida Blue Juxtapid (lomitapide) requires prior authorization from Florida Blue and is typically placed on Tier 6 (Non-Preferred Specialty). To get approval: 1) Your doctor must submit genetic testing confirming homozygous familial hypercholesterolemia (HoFH) with bi-allelic pathogenic variants, 2) Document failed trials of PCSK9

How to Renew Epidiolex (Cannabidiol) Coverage with Aetna CVS Health in Florida: 2024-2025 Timeline and Requirements

Answer Box: Epidiolex Renewal with Aetna CVS Health in Florida Aetna CVS Health requires annual prior authorization renewal for Epidiolex for patients with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex. Start your renewal 60 days before expiration to avoid gaps. You'll need documented clinical response (seizure reduction)