Topic

Florida

A collection of 417 issues

Getting Elzonris (Tagraxofusp-erzs) Covered by Aetna CVS Health in Florida: Prior Authorization, Appeals & Financial Assistance Guide

Answer Box: Getting Elzonris Covered by Aetna in Florida Elzonris (tagraxofusp-erzs) requires prior authorization from Aetna CVS Health for BPDCN treatment. The fastest path: 1) Confirm your plan's formulary status at aetna.com/formulary, 2) Submit PA request with BPDCN pathology report and treatment history via phone (1-855-240-0535)

Oxbryta (Voxelotor) Coverage by Humana in Florida: Understanding the 2024 Withdrawal and Your Alternative Options

Answer Box: Oxbryta Coverage Status Oxbryta (voxelotor) is no longer covered by Humana or any U.S. insurer as of September 2024, when Pfizer voluntarily withdrew the drug due to FDA safety concerns showing increased vaso-occlusive crises and deaths. Your path forward: Work with your hematologist to transition to FDA-approved

How to Get Kalydeco (ivacaftor) Covered by Humana in Florida: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Kalydeco Covered by Humana in Florida Kalydeco (ivacaftor) requires prior authorization from Humana and is typically placed on Tier 5 (Specialty) with higher cost-sharing. Your cystic fibrosis specialist must submit genetic testing results confirming a responsive CFTR mutation (like G551D or R117H), clinical documentation, and a medical

How to Get Kuvan (Sapropterin) Approved by Florida Blue Cross Blue Shield: Prior Authorization Guide with Appeal Templates

Answer Box: Getting Kuvan Approved by Florida Blue in 2024 Kuvan (sapropterin) requires prior authorization from Florida Blue Cross Blue Shield for PKU treatment. The fastest path to approval: (1) Submit PA request via CoverMyMeds platform or Availity with confirmed PKU diagnosis and BH4 responsiveness testing showing ≥30% phenylalanine reduction,

Myths vs. Facts: Getting Pemazyre (Pemigatinib) Covered by Humana in Florida

Answer Box: The Reality of Pemazyre (Pemigatinib) Coverage by Humana in Florida Quick Facts: Pemazyre requires prior authorization from Humana Medicare Advantage plans in Florida. Key requirements include documented FGFR2 fusion/rearrangement testing, comprehensive ophthalmologic monitoring plan, and prior therapy history. Appeals must be filed within 65 days; expedited review

How to Get Spinraza (nusinersen) Covered by Humana in Florida: Complete Approval Guide

Answer Box: Getting Spinraza Covered by Humana in Florida Spinraza (nusinersen) requires prior authorization from Humana in Florida. You'll need genetic confirmation of 5q SMA, baseline motor function testing (HFMSE/RULM), and a specialist prescriber. Submit through Humana's provider portal or call 1-866-488-5995. If denied, you

How to Get Cerezyme (Imiglucerase) Covered by Cigna in Florida: Complete Prior Authorization and Appeals Guide

Quick Answer: Do You Qualify for Cerezyme Coverage by Cigna in Florida? Yes, if you have confirmed Type 1 Gaucher disease with clinical symptoms. Cigna covers Cerezyme (imiglucerase) through Express Scripts/Accredo with prior authorization. Your fastest path: Have your specialist submit a complete PA request via CoverMyMeds with enzyme/

Blue Cross Blue Shield Florida Coverage Criteria for Alecensa (Alectinib): Complete Guide to Prior Authorization Requirements

Answer Box: Getting Alecensa Covered by Blue Cross Blue Shield in Florida To get Alecensa (alectinib) covered by Blue Cross Blue Shield in Florida, you need: (1) confirmed ALK-positive non-small cell lung cancer with molecular testing documentation, (2) prior authorization approval through your provider, and (3) prescription filled through an

Get Lamzede (velmanase alfa-tycv) Covered by Cigna in Florida: Doctor Collaboration Guide

Answer Box: Your Fastest Path to Approval To get Lamzede (velmanase alfa-tycv) covered by Cigna in Florida, you'll need prior authorization with documented alpha-mannosidosis diagnosis, enzyme deficiency testing, and medical necessity justification. Your doctor submits the PA request through CoverMyMeds or Cigna's provider portal. If denied,

How to Get Qalsody (Tofersen) Covered by UnitedHealthcare in Florida: Prior Authorization, Appeals, and Provider Partnership Guide

Quick Answer: Getting Qalsody Covered by UnitedHealthcare in Florida Qalsody (tofersen) requires prior authorization through OptumRx for all UnitedHealthcare plans in Florida. Essential requirements include documented SOD1 gene mutation, ALS diagnosis by a neurologist, baseline ALSFRS-R score, and confirmation the patient isn't on invasive ventilation. Submit PA requests