Topic

Georgia

A collection of 467 issues

How to Get Gilenya (Fingolimod) Covered by Cigna in Georgia: Appeals, Forms, and State Protections

Answer Box: Getting Gilenya (Fingolimod) Covered by Cigna in Georgia Gilenya requires prior authorization from Cigna in Georgia. Your doctor must submit documentation including baseline EKG and eye exam results, plus proof of relapsing MS diagnosis. If denied, you have 180 days for internal appeals and 60 days for external

How to Get Carbaglu (Carglumic Acid) Covered by Humana in Georgia: Appeals Guide and State Protections

Answer Box: Getting Carbaglu Covered by Humana in Georgia Carbaglu (carglumic acid) requires prior authorization from Humana Medicare Advantage plans in Georgia. The fastest path to approval: 1) Submit PA with genetic test confirming NAGS deficiency, elevated ammonia levels, and prescriber attestation of medical necessity, 2) If denied, file internal

Myths vs. Facts: Getting Hemgenix (etranacogene dezaparvovec) Covered by Cigna in Georgia

Answer Box: Getting Hemgenix (etranacogene dezaparvovec) Covered by Cigna in Georgia Eligibility: Adults with hemophilia B, Factor IX activity ≤2%, currently on prophylaxis OR history of serious bleeding, no inhibitors, normal liver function. Fastest approval path: Submit complete prior authorization through Accredo specialty pharmacy with all required labs and hematologist

Oxbryta (Voxelotor) Denied by Aetna (CVS Health) in Georgia: Understanding the 2024 FDA Withdrawal and Your Appeal Options

Answer Box: Oxbryta (Voxelotor) Coverage Status Oxbryta (voxelotor) is no longer FDA-approved as of September 2024 due to safety concerns showing increased vaso-occlusive crises and deaths. Aetna (CVS Health) now denies all Oxbryta claims based on loss of FDA approval. Your next steps in Georgia: 1) Consult your hematologist immediately

How to Get Elevidys Covered by Cigna in Georgia: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Elevidys Covered by Cigna in Georgia Elevidys requires prior authorization from Cigna in Georgia. Your fastest path to approval: (1) Have your doctor submit PA electronically via CoverMyMeds with complete DMD genetic testing and clinical documentation, (2) If denied, file an internal appeal within 180 days, and

Myths vs. Facts: Getting Filspari (sparsentan) Covered by Humana in Georgia (Complete Guide)

Answer Box: Getting Filspari (sparsentan) covered by Humana in Georgia requires prior authorization with specific documentation: confirmed IgA nephropathy diagnosis by biopsy, eGFR ≥30 ml/min/1.73m², proteinuria ≥1.0 g/day, failed trials of ACE inhibitors/ARBs and glucocorticoids, plus REMS enrollment. First step today: Contact your nephrologist

How to Get Xywav (Ca/Mg/K/Na oxybates) Covered by Aetna CVS Health in Georgia: Complete Appeals Guide

Quick Answer: Xywav Coverage by Aetna CVS Health in Georgia Yes, Aetna CVS Health covers Xywav (Ca/Mg/K/Na oxybates) for FDA-approved uses in Georgia, but requires prior authorization. The fastest path: Complete REMS enrollment, gather comprehensive sleep study documentation (PSG, MSLT, sleep logs), and submit through Availity portal.

Myths vs. Facts: Getting Vyondys 53 (Golodirsen) Covered by Blue Cross Blue Shield in Georgia

Answer Box: Getting Vyondys 53 Covered by BCBS Georgia Vyondys 53 (golodirsen) requires prior authorization from Blue Cross Blue Shield in Georgia. Success depends on genetic testing confirming an exon 53-skippable DMD mutation, comprehensive clinical documentation, and proper submission through Anthem's provider portal. If denied, you have 60

How to Get Pyrukynd (Mitapivat) Covered by Cigna in Georgia: Complete Appeals Guide and Timeline

Answer Box: Getting Pyrukynd (Mitapivat) Covered by Cigna in Georgia Pyrukynd (mitapivat) is covered by Cigna as a Tier 4 specialty medication requiring prior authorization and specialty pharmacy dispensing. In Georgia, you have 60 days to file external review after internal appeal denial. Fastest path: Have your hematologist submit prior

How to Get Bylvay (Odevixibat) Covered by Aetna CVS Health in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Bylvay Covered by Aetna CVS Health in Georgia Bylvay (odevixibat) requires prior authorization through Aetna CVS Health and is listed as "not formulary" on most plans, requiring a medical necessity exception. Your fastest path to approval: 1) Confirm genetic diagnosis of PFIC or Alagille syndrome,