Topic

Florida

A collection of 395 issues

Get Signifor LAR (Pasireotide) Covered by Blue Cross Blue Shield in Florida: 2025 Prior Authorization Guide

Quick Answer: Your Path to Coverage Yes, Florida Blue covers Signifor LAR (pasireotide) for Cushing's disease and acromegaly, but requires prior authorization. The fastest path: ensure your endocrinologist has documented failed surgery or contraindications, recent labs (UFC for Cushing's, IGF-1 for acromegaly), and baseline tests within

Coding That Helps Get Tegsedi (inotersen) Approved by Cigna in Florida: ICD-10, HCPCS/J-Code, and NDC Guide

Answer Box: Getting Tegsedi (inotersen) Coded Correctly for Cigna Coverage in Florida Fastest path to approval: Use ICD-10 code E85.1 (neuropathic heredofamilial amyloidosis), HCPCS J3490 (unclassified drugs) with NDC 72126-0007-02, and submit via Cigna's electronic PA system through Express Scripts/Accredo. Tegsedi requires prior authorization under the

Do You Qualify for Ilaris (Canakinumab) Coverage by UnitedHealthcare in Florida? Decision Tree & Next Steps

Quick Answer: UnitedHealthcare requires prior authorization for Ilaris (canakinumab) across all Florida plans. You're most likely to qualify if you have confirmed Still's disease, periodic fever syndrome, or gout flares with documented failure of standard therapies, and a rheumatologist/nephrologist prescriber. First step today: Verify your

How to Get Myozyme (alglucosidase alfa) Covered by Blue Cross Blue Shield of Florida: Complete Timeline and Appeals Guide

Quick Answer: Getting Myozyme Covered by Florida Blue Myozyme (alglucosidase alfa) requires prior authorization from Blue Cross Blue Shield of Florida for all outpatient infusions. The fastest path: (1) Have your Pompe specialist gather diagnostic proof (enzyme assay + genetic testing), (2) Submit complete PA through Availity portal with clinical documentation,

The Requirements Checklist to Get Naglazyme (Galsulfase) Covered by UnitedHealthcare in Florida: Forms, Appeals, and Clinical Criteria

Answer Box: Getting Naglazyme Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Naglazyme (galsulfase) through OptumRx, with no step therapy requirements identified for MPS VI. Submit via UnitedHealthcare Provider Portal with confirmed MPS VI diagnosis (enzyme assay or genetic testing), baseline functional assessments, and medical necessity letter. First

Getting Fabrazyme (Agalsidase Beta) Covered by Florida Blue Cross Blue Shield: Prior Authorization, Appeals, and Step Therapy Guide

Quick Answer: Fabrazyme Coverage with Florida Blue Florida Blue requires prior authorization for Fabrazyme (agalsidase beta) through their Medical Coverage Guideline 09-J2000-59. You'll need confirmed Fabry disease diagnosis (enzyme deficiency or GLA gene mutation), prescription by a Fabry specialist, and submission via Availity portal. Standard review takes 30

How to Get Krystexxa (Pegloticase) Covered by Florida Blue Cross Blue Shield: Complete Prior Authorization and Appeals Guide 2025

Answer Box: Getting Krystexxa Covered by Florida Blue Cross Blue Shield Florida Blue requires prior authorization for Krystexxa (pegloticase) with strict step-therapy and lab requirements. You must document failure of xanthine oxidase inhibitors (allopurinol/febuxostat), G6PD screening, and persistent serum uric acid >6 mg/dL. Submit via provider portal

The Requirements Checklist to Get Carbaglu (Carglumic Acid) Covered by Blue Cross Blue Shield in Florida: Complete Prior Authorization Guide

Quick Answer: Getting Carbaglu Covered by Blue Cross Blue Shield in Florida Carbaglu (carglumic acid) requires prior authorization under Florida Blue plans and is exclusively dispensed through Accredo Specialty Pharmacy. The fastest path to approval: (1) Confirm your diagnosis with genetic testing for NAGS deficiency, (2) Document elevated plasma ammonia

How to Get Koselugo (selumetinib) Covered by Aetna (CVS Health) in Florida: Complete Prior Authorization Guide

Answer Box: Getting Koselugo (selumetinib) Covered by Aetna (CVS Health) in Florida Koselugo (selumetinib) is typically covered by Aetna (CVS Health) as a specialty medication with prior authorization for pediatric patients ≥2 years with NF1 and symptomatic, inoperable plexiform neurofibromas. The fastest path to approval: 1) Have your pediatric oncologist

How to Get Emflaza (Deflazacort) Covered by Humana in Florida: Complete Coding, Prior Authorization & Appeals Guide

Answer Box: Getting Emflaza Covered by Humana in Florida Emflaza (deflazacort) requires prior authorization from Humana Medicare plans in Florida. The fastest path to approval: 1) Verify your plan's formulary status at Humana's drug list tool, 2) Have your prescriber submit a Medicare Prescription Drug Coverage