Topic

Florida

A collection of 395 issues

Get Waylivra (Volanesorsen) Covered by UnitedHealthcare in Florida: Complete Guide to Forms, Appeals, and Approval

Quick Answer: Getting Waylivra Covered in Florida Waylivra (volanesorsen) requires prior authorization through UnitedHealthcare's OptumRx system in Florida. Submit PA requests via the UnitedHealthcare Provider Portal with confirmed FCS diagnosis, triglyceride levels >880 mg/dL, and prior therapy documentation. If denied, file internal appeals within 180 days,

How to Get Besponsa (Inotuzumab Ozogamicin) Covered by Aetna CVS Health in Florida: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Quick Path to Besponsa Coverage with Aetna CVS Health in Florida Besponsa (inotuzumab ozogamicin) requires prior authorization from Aetna CVS Health for all Florida plans. Your oncologist must submit documentation proving relapsed/refractory CD22-positive B-cell precursor ALL, prior therapy failures, and liver monitoring plans. Standard decisions take 72

How to Get Prolastin-C Covered by Blue Cross Blue Shield in Florida: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Prolastin-C Approved by Florida Blue Cross Blue Shield To get Prolastin-C covered by Blue Cross Blue Shield in Florida, you need prior authorization showing severe alpha-1 antitrypsin deficiency (AAT level <57 mg/dL, Pi*ZZ genotype), emphysema with FEV1 25-80% predicted, and proper ICD-10 coding (E88.

How to Get Raxone (Idebenone) Covered by Humana in Florida: Prior Authorization, Appeals & Templates

Answer Box: Getting Raxone (Idebenone) Covered by Humana in Florida Raxone (idebenone) requires prior authorization from Humana and faces frequent denials since it's not FDA-approved in the US. Your fastest path: (1) Have your specialist submit a detailed medical necessity letter documenting LHON diagnosis with genetic confirmation, (2)

How to Get Rylaze (asparaginase erwinia chrysanthemi [recombinant]-rywn) Covered by Blue Cross Blue Shield Florida: Complete Guide to Forms, Appeals, and Approval

Answer Box: Fast Track to Rylaze Coverage Getting Rylaze (asparaginase erwinia chrysanthemi [recombinant]-rywn) covered by Florida Blue Cross Blue Shield requires prior authorization with documented E. coli asparaginase hypersensitivity. Submit the PA request through Availity.com with complete allergy documentation, treatment history, and clinical justification. Florida Blue typically decides

Do You Qualify for Bylvay (odevixibat) Coverage by Blue Cross Blue Shield in Florida? Decision Tree & Next Steps

Answer Box: Quick Qualification Check Florida Blue requires prior authorization for Bylvay (odevixibat) with strict criteria: age ≥3 months (PFIC) or ≥12 months (Alagille), genetic testing confirmation, documented moderate-to-severe pruritus, and failure of ursodeoxycholic acid plus one alternative (cholestyramine, rifampin, or antihistamine). Submit via Availity.com or call 1-877-719-2583. If

Aetna (CVS Health) Coverage Criteria for Prolastin-C in Florida: What Counts as "Medically Necessary"?

Answer Box To get Prolastin-C covered by Aetna (CVS Health) in Florida, you need: 1) Confirmed severe AAT deficiency (Pi*ZZ genotype + serum AAT <57 mg/dL), 2) Post-bronchodilator FEV₁ between 25-80% predicted, and 3) Documentation of emphysema/COPD due to AAT deficiency. Submit prior authorization using Aetna'

How to Get Evrysdi (risdiplam) Covered by Blue Cross Blue Shield in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Evrysdi Approved by Blue Cross Blue Shield in Florida Evrysdi (risdiplam) requires prior authorization from Blue Cross Blue Shield plans in Florida. To get approved: (1) Have your neurologist submit a complete PA request with genetic testing confirming 5q-SMA, baseline motor assessments, and prior therapy history via

Get Pemazyre (Pemigatinib) Covered by Blue Cross Blue Shield in Florida: Complete PA Guide with Forms and Appeals

Answer Box: Quick Path to Pemazyre Coverage in Florida Blue Cross Blue Shield of Florida requires prior authorization for Pemazyre (pemigatinib) based on confirmed FGFR2 fusion/rearrangement testing, prior therapy documentation, and baseline eye exam. Submit PA via Florida Blue provider portal or fax 1-904-348-3295 with genetic test results, pathology

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