Topic

Florida

A collection of 395 issues

Myths vs. Facts: Getting Ocrevus (ocrelizumab) Covered by Aetna (CVS Health) in Florida

Answer Box: Getting Ocrevus Covered by Aetna in Florida Eligibility: Aetna covers Ocrevus for relapsing MS and primary progressive MS when prescribed by or in consultation with a neurologist. Fastest path: Submit complete prior authorization at least 2 weeks before treatment with MS diagnosis confirmation, prior therapy documentation, and hepatitis

How to Get Defitelio (Defibrotide) Covered by Aetna CVS Health in Florida: Complete Prior Authorization and Appeals Guide

Quick Start: Getting Defitelio (Defibrotide) Approved by Aetna CVS Health in Florida Defitelio requires prior authorization from Aetna CVS Health for hepatic veno-occlusive disease (VOD) treatment following hematopoietic stem cell transplant. Your transplant team must document VOD using Baltimore or Cairo criteria plus organ dysfunction. Submit through Aetna's

Getting Raxone (Idebenone) Covered by Cigna in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Raxone (Idebenone) Covered by Cigna in Florida Key Challenge: Raxone (idebenone) is not FDA-approved in the US, making coverage extremely difficult through standard channels. Fastest path: Request a formulary exception with comprehensive medical necessity documentation for LHON treatment. First step today: Contact your prescribing physician to initiate

How to Get Sylvant (Siltuximab) Covered by Humana in Florida: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Sylvant Approved by Humana in Florida Sylvant (siltuximab) requires prior authorization from Humana before coverage. The fastest path to approval: 1) Confirm your diagnosis of idiopathic multicentric Castleman disease with negative HIV/HHV-8 tests, 2) Have your oncologist submit a complete PA packet through Humana's

How to Get Somatuline Depot (Lanreotide) Covered by Aetna CVS Health in Florida: Complete Prior Authorization Guide

Answer Box: Getting Somatuline Depot Covered by Aetna CVS Health in Florida Fastest path to approval: Submit Aetna's Somatuline Depot Precertification Request form (GR-69561) with complete clinical documentation showing medical necessity for acromegaly, GEP-NETs, or carcinoid syndrome. Use the Availity provider portal for fastest processing (72-hour decisions vs.

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Humana in Florida: Prior Authorization, Appeals, and Medical Necessity Requirements

Quick Answer: Getting Enhertu Covered by Humana in Florida To get Enhertu (fam-trastuzumab deruxtecan-nxki) covered by Humana in Florida, you'll need prior authorization with HER2 testing results and documented treatment history. Submit through your oncologist via Humana's provider portal with clinical notes showing medical necessity. If

Work With Your Doctor to Get Garadacimab (Andembry) Approved by Cigna in Florida: Complete Prior Authorization Guide

Answer Box: Getting Garadacimab Covered by Cigna in Florida Fastest Path: Your physician must submit a prior authorization request through Cigna's provider portal or EviCore, documenting confirmed HAE diagnosis with lab values (low C4, C1-INH deficiency), attack frequency, failed alternatives, and completed REMS training. Timeline: 2 business days

The Requirements Checklist to Get Opdivo (Nivolumab) Covered by Humana in Florida: Forms, Appeals, and Medical Necessity

Answer Box: Getting Opdivo Covered by Humana in Florida Eligibility: Opdivo (nivolumab) requires prior authorization for all Humana Medicare Advantage plans in Florida. Coverage falls under Part B medical benefits, not Part D pharmacy coverage. Fastest approval path: Your oncologist submits a complete prior authorization request through Humana's

How to Get Signifor LAR (Pasireotide) Covered by Cigna in Florida: Appeals, Prior Authorization & Cost Assistance

Answer Box: Getting Signifor LAR Covered by Cigna in Florida Fastest path to approval: Submit prior authorization through CoverMyMeds or EviCore portal with complete endocrine labs (UFC for Cushing's, IGF-1 for acromegaly), specialist prescriber documentation, and evidence of prior therapy failures. Cigna classifies Signifor LAR as Tier 4

How to Get Dojolvi (Triheptanoin) Covered by UnitedHealthcare in Florida: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Dojolvi Covered by UnitedHealthcare in Florida Fast track to approval: Submit prior authorization with molecular/genetic confirmation of LC-FAOD from a board-certified medical geneticist, discontinue all MCT products, and include a detailed dietary management plan. If denied, file an internal appeal within 180 days citing Florida'