Topic

Florida

A collection of 477 issues

Blue Cross Blue Shield Florida's Coverage Criteria for Opfolda (miglustat): What Counts as "Medically Necessary"?

Answer Box: Getting Opfolda (miglustat) Approved by Blue Cross Blue Shield in Florida Quick Answer: Opfolda requires prior authorization from Blue Cross Blue Shield Florida and must be prescribed with Pombiliti for late-onset Pompe disease patients ≥40kg who aren't improving on current enzyme replacement therapy. Fastest path: Have

How to Get Oxlumo (lumasiran) Covered by UnitedHealthcare in Florida: Complete Guide with Forms, Appeals, and Timelines

Answer Box: UnitedHealthcare requires prior authorization for Oxlumo (lumasiran) in Florida, with approval typically requiring: (1) confirmed PH1 diagnosis via AGXT genetic testing, (2) specialist prescriber (nephrologist/geneticist), (3) elevated urinary oxalate levels, and (4) eGFR ≥30 mL/min/1.73 m². First step today: Have your nephrologist or geneticist

If Strimvelis (ADA-SCID Gene Therapy) Isn't Approved by Blue Cross Blue Shield in Florida: Alternative Treatments & Exception Paths

Answer Box: Your Options When Strimvelis Gene Therapy Is Denied If Blue Cross Blue Shield (BCBS) in Florida denies Strimvelis gene therapy for ADA-SCID, you have three main paths: PEG-ADA enzyme replacement therapy as a bridge treatment, allogeneic stem cell transplant if a donor is available, or formulary exception appeal

How to Get Entresto (sacubitril/valsartan) Covered by Cigna in Florida: Appeals, Forms, and Medical Necessity Requirements

Quick Answer: Getting Entresto Covered by Cigna in Florida Fastest path to approval: Submit prior authorization with documented heart failure diagnosis (LVEF ≤40%), NYHA class, and prior ACE inhibitor/ARB failure or intolerance. If denied, file internal appeal within 180 days citing Florida step-therapy protections. Start today: Call Cigna at

Denied for Turalio (pexidartinib) by UnitedHealthcare in Florida? How to Appeal (Templates & Timelines)

Answer Box: Getting Turalio (pexidartinib) Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Turalio (pexidartinib) with strict criteria: confirmed TGCT diagnosis, unresectable disease, and REMS enrollment. If denied, request a peer-to-peer review within 24-72 hours, then file internal appeals within 180 days. Florida offers binding external review through

How to Get Ferriprox (deferiprone) Covered by Blue Cross Blue Shield in Florida: Complete PA Guide with Appeal Scripts

Answer Box: Getting Ferriprox Covered by Florida Blue Ferriprox (deferiprone) is typically a Tier 6 specialty drug requiring prior authorization through Florida Blue's Prime Therapeutics system. The fastest approval path involves: 1) Confirming your plan's formulary status via My Health Toolkit, 2) Having your prescriber submit

How Long Does It Take to Get Cresemba (Isavuconazole) Approved by Blue Cross Blue Shield in Florida? Complete Timeline Guide

Answer Box: Getting Cresemba Approved in Florida Blue Cross Blue Shield of Florida typically requires prior authorization for Cresemba (isavuconazole) with 2-3 business days for electronic submissions and up to 14 calendar days for fax requests. The fastest path: have your infectious disease specialist submit complete documentation via electronic PA

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

Quick Answer: Getting Elaprase (Idursulfase) Covered by Cigna in Florida Cigna requires prior authorization for Elaprase (idursulfase), the only FDA-approved enzyme replacement therapy for Hunter syndrome (MPS II). You'll need enzymatic confirmation of iduronate-2-sulfatase deficiency, genetic testing showing IDS gene mutation, and weight-based dosing at 0.5 mg/

How to Get Revlimid (lenalidomide) Approved by Aetna CVS Health in Florida: Complete Timeline and Appeals Guide

Answer Box: Getting Revlimid Covered by Aetna CVS Health in Florida Revlimid (lenalidomide) requires prior authorization from Aetna CVS Health, with decisions typically within 3-5 business days (or 72 hours if expedited). The fastest path: ensure REMS certification, submit complete PA documentation via Availity portal, and include diagnosis codes, prior

How to Get Voydeya (danicopan) Covered by Humana in Florida: Forms, Appeals Timeline & Specialty Pharmacy Guide

Quick Answer: Getting Voydeya (danicopan) Covered by Humana in Florida Voydeya requires prior authorization from Humana with proof of PNH diagnosis, concurrent C5 inhibitor use, and evidence of extravascular hemolysis despite optimized therapy. Submit PA via Humana's PromptPA portal or Availity with flow cytometry results, vaccination records, and