Topic

Florida

A collection of 418 issues

How to Get Opsumit (Macitentan) Covered by Humana in Florida: Appeals Guide with Forms and Timelines

Answer Box: Getting Opsumit (Macitentan) Covered by Humana in Florida Fastest Path to Approval: Submit a prior authorization request with complete PAH documentation including right heart catheterization results, WHO functional class, and REMS pregnancy testing compliance. If denied, file an appeal within 65 days using Humana's online portal

How to Get Chenodal (Chenodiol) Approved by Blue Cross Blue Shield in Florida: Complete PA Guide with Appeals Process

Answer Box: Getting Chenodal Covered by Florida Blue Cross Blue Shield Chenodal (chenodiol) requires prior authorization from Blue Cross Blue Shield of Florida. To get approved, you need: (1) documented radiolucent gallstones on imaging, (2) proof you're not a surgical candidate, and (3) evidence of failed ursodiol trial.

How to Get Evkeeza (Evinacumab) Covered by Humana in Florida: Appeals, Forms & Timeline Guide

Quick Answer: Getting Evkeeza Covered by Humana in Florida Evkeeza (evinacumab) requires prior authorization from Humana Medicare Advantage plans in Florida. Submit clinical documentation confirming homozygous familial hypercholesterolemia (HoFH) diagnosis, prior therapy failures, and current lipid levels. If denied, you have 65 days to appeal with additional evidence. For urgent

Lowering Out-of-Pocket Costs for Pyrukynd (Mitapivat) with UnitedHealthcare in Florida: Complete Coverage and Savings Guide

Answer Box: Getting Pyrukynd Covered by UnitedHealthcare in Florida Pyrukynd (mitapivat) requires prior authorization from UnitedHealthcare and must be filled through OptumRx specialty pharmacies. Your hematologist must document genetic confirmation of pyruvate kinase deficiency (≥2 PKLR variants with ≥1 missense mutation) plus clinical severity criteria. The drug typically costs 20-30%

The Requirements Checklist to Get Turalio (Pexidartinib) Covered by Aetna (CVS Health) in Florida

Quick Answer: Getting Turalio Covered by Aetna (CVS Health) in Florida Who qualifies: Patients with symptomatic tenosynovial giant cell tumor (TGCT) not amenable to surgery, causing severe morbidity or functional limitations. Fastest path: Complete Aetna's prior authorization form with REMS enrollment documentation, surgical contraindication evidence, and detailed medical

How to Get Lamzede (velmanase alfa-tycv) Covered by Aetna CVS Health in Florida: Forms, Appeals, and Provider Contacts

Answer Box: Getting Lamzede Covered by Aetna CVS Health in Florida Fastest Path: Submit Aetna's specialty medication prior authorization form with genetic testing results (MAN2B1 variants) or enzyme deficiency documentation. Use fax 1-888-267-3277 or the Availity portal. If denied, file an internal appeal within 180 days, then request

Cigna's Coverage Criteria for Evkeeza (evinacumab-dgnb) in Florida: What Counts as "Medically Necessary"?

Quick Answer: To get Evkeeza (evinacumab-dgnb) covered by Cigna in Florida, you need: (1) confirmed HoFH diagnosis with genetic testing or clinical criteria, (2) documented failure of PCSK9 inhibitor therapy for 8+ weeks with LDL-C ≥70 mg/dL, and (3) prescription from a lipid specialist. Start by gathering your genetic

How to Get Tysabri (Natalizumab) Covered by Cigna in Florida: Prior Authorization, Appeals, and State Protections

Answer Box: Get Tysabri Covered by Cigna in Florida Cigna requires prior authorization for Tysabri (natalizumab) with strict TOUCH program enrollment and medical necessity documentation. In Florida, you have enhanced protections including step therapy exemptions and external review rights. First step: Ensure your prescriber, infusion site, pharmacy, and you are

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 Xenpozyme (olipudase alfa-rpcp) Covered by Aetna (CVS Health) in Florida: Complete Appeals Guide with Templates

Answer Box: Getting Xenpozyme Covered by Aetna (CVS Health) in Florida Xenpozyme (olipudase alfa-rpcp) requires prior authorization from Aetna (CVS Health) with strict criteria: confirmed ASMD diagnosis via genetic testing or enzyme assay, specialist involvement, and CVS Specialty Pharmacy dispensing. Fastest approval path: 1) Ensure genetic/enzyme confirmation is documented,