Topic

Florida

A collection of 477 issues

How to Get Orladeyo (Berotralstat) Covered by Aetna CVS Health in Florida: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Orladeyo Covered by Aetna CVS Health in Florida Orladeyo (berotralstat) requires prior authorization from Aetna CVS Health for hereditary angioedema (HAE) prophylaxis. Your fastest path to approval: (1) Confirm HAE diagnosis with C1-INH lab results and clinical criteria, (2) Document any failed prior therapies, and (3) Have

How to Get Venclexta (venetoclax) Covered by UnitedHealthcare in Florida: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Venclexta Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Venclexta (venetoclax) in Florida, with step therapy requirements typically mandating BTK inhibitor trials first. Your fastest path: gather baseline TLS monitoring labs, document failed alternatives, and submit via the UnitedHealthcare provider portal. If denied, you have

How to Get Daybue (Trofinetide) Covered by Humana in Florida: Complete Prior Authorization Guide

Answer Box: Getting Daybue (Trofinetide) Covered by Humana in Florida Daybue (trofinetide) requires prior authorization from Humana Medicare Advantage plans in Florida. The fastest path to approval: (1) Confirm Rett syndrome diagnosis with genetic testing (MECP2), (2) Submit PA request through Humana's provider portal with specialist attestation and

Myths vs. Facts: Getting iLink® Corneal Cross-Linking Covered by Humana in Florida

Answer Box: iLink® Coverage Through Humana in Florida Quick Facts: Humana Medicare Advantage covers FDA-approved iLink® corneal cross-linking for progressive keratoconus with prior authorization. You need documented progression (≥1.0 D keratometry increase or ≥10 µm corneal thinning over 12 months) and failed conservative treatment. First step: Call Humana at

Do You Qualify for Soliris (Eculizumab) Coverage by Cigna in Florida? Decision Tree & Next Steps

Answer Box: Soliris (Eculizumab) Coverage by Cigna in Florida Cigna requires prior authorization for Soliris (eculizumab) with 72-hour standard review (24 hours expedited). Key requirements: FDA-approved diagnosis confirmation, meningococcal vaccination ≥2 weeks before treatment, REMS enrollment, and prior therapy documentation. Submit via CoverMyMeds or provider portal. If denied, internal appeals

How to Get Adynovate (bdanocog alfa pegol) Covered by Humana in Florida: Complete Prior Authorization Guide

Answer Box: Getting Adynovate Covered by Humana in Florida Humana Medicare Advantage plans in Florida require prior authorization for Adynovate (bdanocog alfa pegol), a specialty hemophilia A treatment. To get approval: (1) Confirm your Humana plan type via MyHumana portal, (2) Have your hematologist submit a prior authorization request with

How to Get Xyrem (Sodium Oxybate) Covered by Cigna in Florida: Prior Authorization, Appeals, and Alternative Paths

Answer Box: Fastest Path to Xyrem Coverage Cigna requires prior authorization for Xyrem (sodium oxybate) in Florida with mandatory step therapy. You must document failure of modafinil, armodafinil, or methylphenidate, plus Wakix for cataplexy cases. Submit PA through your sleep specialist with PSG/MSLT results, prior therapy records, and REMS

How to Get Palynziq (pegvaliase-pqpz) Covered by Humana in Florida: Timeline, Appeals, and Forms

Answer Box: Getting Palynziq (pegvaliase-pqpz) Covered by Humana in Florida Palynziq (pegvaliase-pqpz) requires prior authorization from Humana for PKU patients ≥18 years with blood phenylalanine >600 µmol/L despite diet restriction. Humana decides within 7 calendar days for standard requests, 72 hours for expedited. If denied, you have 65

How to Get Opzelura (ruxolitinib cream) Covered by Humana in Florida: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Opzelura (ruxolitinib cream) Covered by Humana in Florida Humana Medicare Advantage requires prior authorization for Opzelura (ruxolitinib cream) for atopic dermatitis and vitiligo. Your fastest path to approval: (1) Verify coverage on your plan's formulary, (2) Document 30-day trials of topical steroids and calcineurin inhibitors

If Thiola / Thiola EC (Tiopronin) Isn't Approved by Blue Cross Blue Shield in Florida: Formulary Alternatives & Exception Paths

Answer Box: Your Options When Thiola / Thiola EC Is Denied If Blue Cross Blue Shield Florida denies Thiola / Thiola EC (tiopronin) for cystinuria, you have three main paths: 1) Try required alternatives like D-penicillamine or conservative therapy first (step therapy), 2) Request a formulary exception with medical necessity documentation, or