Topic

Florida

A collection of 395 issues

How to Get Pomalyst (Pomalidomide) Covered by UnitedHealthcare in Florida: Coding, Appeals, and REMS Requirements

Answer Box: Getting Pomalyst Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Pomalyst (pomalidomide) with specific documentation: C90.02 (multiple myeloma in relapse) ICD-10 code, proof of prior lenalidomide and proteasome inhibitor failure, and PS-Pomalidomide REMS enrollment. Submit via the UHC Provider Portal with pathology reports, treatment history,

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

Answer Box: Getting Kymriah (tisagenlecleucel) Covered by Cigna in Florida Kymriah requires prior authorization through Cigna's medical benefit in Florida. Start with the Florida Medical Prior Authorization Form and submit via fax (866-873-8279) or online portal. Your clinic must document CD19-positive disease, prior therapy failures, and treatment at

Get Tagrisso (Osimertinib) Covered by Blue Cross Blue Shield in Florida: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Tagrisso Covered by Blue Cross Blue Shield in Florida Yes, Blue Cross Blue Shield plans in Florida cover Tagrisso (osimertinib) with prior authorization for EGFR-mutant non-small cell lung cancer. The fastest path to approval requires: (1) documented EGFR sensitizing mutation (exon 19 deletion or L858R), (2) appropriate

UnitedHealthcare's Coverage Criteria for Acthar Gel in Florida: What Counts as "Medically Necessary"?

Answer Box: Getting Acthar Gel Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Acthar Gel with strict medical necessity criteria. Coverage is primarily limited to infantile spasms in children under 2 years old (4-week approval) and select conditions like opsoclonus-myoclonus syndrome. Most other uses require documented failure of

Getting Aldurazyme (Laronidase) Covered by UnitedHealthcare in Florida: Copay Assistance, Appeals, and Cost-Saving Strategies

Answer Box: Fast Track to Aldurazyme Coverage UnitedHealthcare requires prior authorization for Aldurazyme (laronidase) with genetic/enzymatic confirmation of MPS I and specialist oversight. Commercial members can use Sanofi's CareConnectPSS copay assistance (up to $15,000 annually), while Medicare/Medicaid members cannot. Florida's 2024 Patient Timely

Get Voydeya (Danicopan) Covered by Aetna CVS Health in Florida: Complete Prior Authorization Guide

Answer Box: Getting Voydeya (danicopan) covered by Aetna CVS Health in Florida requires prior authorization proving you have PNH with extravascular hemolysis despite C5 inhibitor therapy. Fastest path: Have your hematologist submit PA via CVS Caremark's electronic portal with flow cytometry results, current C5 inhibitor details, and labs

How to Get Qinlock (ripretinib) Covered by Cigna in Florida: Prior Authorization, Appeals, and Timeline Guide

Answer Box: Getting Qinlock Covered by Cigna in Florida Qinlock (ripretinib) requires prior authorization from Cigna for advanced GIST patients who've failed at least three kinase inhibitors (imatinib, sunitinib, regorafenib). Your oncologist must submit documentation proving prior TKI failures, current disease status, and NCCN guideline support. If denied,

How to Get Tavneos (avacopan) Covered by UnitedHealthcare in Florida: Complete Prior Authorization Guide with Appeals Timeline

Answer Box: Getting Tavneos Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Tavneos (avacopan) in Florida, with strict criteria requiring severe active ANCA-associated vasculitis (GPA/MPA) and use alongside standard therapy. Fastest path to approval: Have your rheumatologist, nephrologist, or pulmonologist submit a PA through the UHC provider

How to Get Joenja (leniolisib) Approved by Cigna in Florida: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Joenja (leniolisib) covered by Cigna in Florida requires genetic confirmation of APDS with pathogenic PIK3CD/PIK3R1 variants, specialist prescriber involvement, and documentation of failed standard therapies. Submit prior authorization via Cigna's portal or Florida PA form (fax 866-873-8279). Expect 72-hour standard review, 24-hour expedited. If

Getting Blenrep (Belantamab Mafodotin) Covered by Aetna CVS Health in Florida: Complete Prior Authorization and Appeal Guide

Answer Box: How to Get Blenrep Covered by Aetna CVS Health in Florida Aetna CVS Health requires prior authorization for Blenrep (belantamab mafodotin) with criteria including ≥4 prior therapy failures, documented disease progression, and REMS enrollment for ocular monitoring. Submit PA via Aetna provider portal with complete treatment history. If