Topic

Georgia

A collection of 467 issues

How to Get Krystexxa (Pegloticase) Covered by Blue Cross Blue Shield in Georgia: Prior Authorization, Appeals, and State Protections Guide

Answer Box: Getting Krystexxa Covered by Blue Cross Blue Shield in Georgia Fastest path to approval: Submit prior authorization through BCBS provider portal with complete documentation of failed xanthine oxidase inhibitor trials (allopurinol/febuxostat), G6PD test results, and rheumatology evaluation. Georgia's step therapy exception law (§33-24-59.25) requires

How to Get Cresemba (Isavuconazole) Covered by Humana in Georgia: Timeline, Forms & Appeal Process

Answer Box: Getting Cresemba Covered by Humana in Georgia Cresemba (isavuconazole) requires prior authorization from Humana with decisions typically within 1 business day for electronic submissions (95% by 2026) or 7 calendar days maximum under CMS rules. Key requirements: invasive aspergillosis or mucormycosis diagnosis, ID specialist involvement, and documented failure/

Lowering Out-of-Pocket for Imbruvica (ibrutinib) with UnitedHealthcare in Georgia: Copay Cards, Tier Exceptions & Appeals

Quick Answer: Getting Imbruvica (ibrutinib) Covered and Affordable in Georgia UnitedHealthcare requires prior authorization for Imbruvica and typically places it on a high specialty tier (Tier 4-5). For commercially insured patients, enroll in the IMBRUVICA By Your Side copay card to pay as little as $0 per prescription. If costs

How to Get Blenrep (Belantamab Mafodotin) Approved by UnitedHealthcare in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Blenrep Covered by UnitedHealthcare in Georgia Important: Blenrep (belantamab mafodotin) was withdrawn from the US market in November 2022 and remains unavailable for commercial coverage. Access is limited to clinical trials or GSK's expanded access program. UnitedHealthcare will deny coverage requests outside these pathways. If

How to Get Firazyr (icatibant injection) Covered by Aetna (CVS Health) in Georgia: Complete Prior Authorization Guide

Answer Box: Getting Firazyr Covered by Aetna (CVS Health) in Georgia Fastest Path to Approval: 1) Have an HAE specialist complete Aetna's Firazyr/icatibant precertification form with confirmed HAE diagnosis and attack history. 2) Submit through CVS Specialty Pharmacy (1-800-237-2767) for processing. 3) If denied, file internal appeal

How to Get Pomalyst (Pomalidomide) Covered by Blue Cross Blue Shield in Georgia: Complete Prior Authorization Guide

Answer Box: Getting Pomalyst Covered by BCBS Georgia Pomalyst (pomalidomide) requires prior authorization from Blue Cross Blue Shield Georgia (Anthem) and must be filled through their specialty pharmacy networks (CarelonRx or BioPlus). To get approved: 1) Your oncologist submits a PA request documenting prior lenalidomide and proteasome inhibitor failure, 2)

Do You Qualify for Alecensa (alectinib) Coverage by Aetna (CVS Health) in Georgia? Complete Decision Tree & Appeals Guide

Answer Box: Quick Eligibility Check You likely qualify for Alecensa (alectinib) coverage by Aetna (CVS Health) if you have ALK-positive NSCLC (either metastatic/recurrent disease or adjuvant therapy after complete tumor resection with tumor ≥4cm or node-positive). First step today: Call the number on your Aetna insurance card to confirm

How to Get Cresemba (Isavuconazole) Covered by Cigna in Georgia: Complete PA Guide with Forms and Appeals Timeline

Answer Box: Cresemba (isavuconazole) requires prior authorization from Cigna for invasive aspergillosis and mucormycosis. Submit PA via CoverMyMeds or Surescripts portal with confirmed diagnosis, culture results, and ID specialist documentation. If denied, you have 180 days for internal appeal, then 60 days for Georgia DOI external review. Start with your

Work With Your Doctor to Get Lutathera Approved by Blue Cross Blue Shield in Georgia: Complete Prior Authorization Guide

Quick Answer: Blue Cross Blue Shield of Georgia (Anthem BCBS GA) requires prior authorization for Lutathera for somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors. You'll need SSTR-positive imaging, documented progression on octreotide/lanreotide, and an oncologist's letter of medical necessity. If denied, Georgia allows external review within 60

How to Get Oxlumo (Lumasiran) Covered by Cigna in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Oxlumo (Lumasiran) Covered by Cigna in Georgia Cigna requires prior authorization for Oxlumo (lumasiran) with strict PH1 criteria: genetic AGXT confirmation, elevated urinary oxalate, and specialist prescriber. Submit the Cigna Oxlumo PA form via CoverMyMeds or fax to 855-840-1678. If denied, request peer-to-peer review by calling 1-800-882-4462,