Topic

Garadacimab (anti-FXIIa) — FDA-approved 2025

A collection of 23 issues

How to Get Garadacimab (Andembry) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Garadacimab Covered by BCBS in Washington Garadacimab (Andembry) requires prior authorization from Blue Cross Blue Shield plans in Washington. Submit a formulary exception request with confirmed HAE diagnosis (ICD-10 D84.1), lab results showing low C4 and C1-INH levels, and documentation of prior therapy failures. If denied,
6 min read

How to Get Garadacimab (Andembry) Covered by Humana in Florida: Formulary Alternatives, Appeals, and Prior Authorization Guide

Answer Box: Getting Garadacimab Covered by Humana in Florida Garadacimab (Andembry) is not on Humana's 2025 formulary, requiring a formulary exception with medical necessity documentation. Your fastest path: (1) Try preferred alternatives like Haegarda or Cinryze first if medically appropriate, (2) Document failure/intolerance to alternatives, then (3)
6 min read

How to Get Garadacimab (Andembry) Covered by UnitedHealthcare in North Carolina: Timeline, Appeals, and Documentation Guide

Answer Box: Getting Garadacimab Covered in North Carolina UnitedHealthcare requires prior authorization for Garadacimab (Andembry) with mandatory step therapy—you must try and fail preferred HAE prophylaxis medications first. Standard approval takes 2-3 business days via OptumRx portal; expedited reviews process within 24-72 hours for urgent cases. If denied, North
7 min read

Myths vs. Facts: Getting Garadacimab Covered by Aetna (CVS Health) in Washington - Complete Prior Authorization Guide

Answer Box: Getting Garadacimab Covered by Aetna in Washington Garadacimab requires prior authorization from Aetna (CVS Health) with confirmed HAE diagnosis, specialist prescription, and often documented failures of step-therapy alternatives. Washington residents have strong appeal rights through the Office of Insurance Commissioner, including expedited reviews (72 hours) and binding external
6 min read

How to Get Garadacimab (Andembry) Covered by Humana in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Garadacimab Covered by Humana in North Carolina Garadacimab (Andembry) requires prior authorization from Humana and faces step therapy requirements. You must document failed trials with preferred HAE prophylaxis medications first. Standard PA decisions take 30 days (72 hours expedited). If denied, Humana Medicare Advantage uses federal appeals;
5 min read