Topic

Hetlioz (tasimelteon)

A collection of 37 issues

Myths vs. Facts: Getting Hetlioz (Tasimelteon) Covered by Cigna in Washington

Answer Box: Hetlioz Coverage Through Cigna in Washington Myth: If your doctor prescribes Hetlioz, Cigna automatically covers it. Fact: Cigna requires prior authorization with documented step therapy (ramelteon + one other sleep medication failure) and specialist confirmation of Non-24-Hour Sleep-Wake Disorder or Smith-Magenis Syndrome. Submit PA forms through the Cigna provider

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

Quick Answer: Getting Hetlioz Approved by Cigna in Florida Getting Hetlioz (tasimelteon) approved by Cigna in Florida requires completing their prior authorization process with comprehensive clinical documentation. You'll need specialist confirmation of Non-24-hour sleep-wake disorder or Smith-Magenis syndrome (ICD-10: G47.24/Q93.82), documented failure of step therapy

How to Get Hetlioz (Tasimelteon) Approved by Humana in Ohio: Complete PA Guide and Appeal Process

Quick Answer: Getting Hetlioz Covered by Humana in Ohio Hetlioz (tasimelteon) is covered by Humana Ohio plans but requires prior authorization on specialty tiers. The fastest path: Have your sleep specialist or neurologist complete Humana's PA form with genetic testing (for SMS) or blindness documentation (for Non-24), proof

Do You Qualify for Hetlioz (Tasimelteon) Coverage by UnitedHealthcare in Virginia? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Hetlioz Coverage To get Hetlioz (tasimelteon) covered by UnitedHealthcare in Virginia, you must have a confirmed diagnosis of Non-24-Hour Sleep-Wake Disorder (with total blindness) or Smith-Magenis Syndrome, plus documented failure of melatonin therapy. The fastest approval path: (1) Have your sleep specialist complete UnitedHealthcare&

How to Get Hetlioz (Tasimelteon) Covered by Blue Cross Blue Shield in Ohio: Prior Authorization Forms, Appeals, and Coding Guide

Quick Answer: Getting Hetlioz Covered by Blue Cross Blue Shield in Ohio Hetlioz (tasimelteon) requires prior authorization from Blue Cross Blue Shield in Ohio. The fastest path to approval involves: 1) Submit a complete PA form with specialist documentation for Non-24 Sleep-Wake Disorder (ICD-10: G47.24) or Smith-Magenis Syndrome (Q93.

Do You Qualify for Hetlioz (Tasimelteon) Coverage by Cigna in North Carolina? Decision Tree & Next Steps

Answer Box: Qualifying for Hetlioz (Tasimelteon) Coverage You likely qualify for Cigna coverage of Hetlioz (tasimelteon) in North Carolina if you have: * Confirmed Non-24-Hour Sleep-Wake Disorder or Smith-Magenis Syndrome diagnosis * Sleep specialist evaluation with 14+ days of sleep logs/actigraphy * Documentation of failed alternative treatments (if step therapy applies) Fastest

UnitedHealthcare's Coverage Criteria for Hetlioz (Tasimelteon) in Texas: What Counts as "Medically Necessary"?

Answer Box: Getting Hetlioz Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Hetlioz (tasimelteon) with strict medical necessity criteria. Coverage is limited to totally blind adults with Non-24-Hour Sleep-Wake Disorder or confirmed Smith-Magenis Syndrome patients (ages 3-15 for oral suspension, 16+ for capsules). Step therapy with melatonin is

How to Get Hetlioz (tasimelteon) Covered by Aetna CVS Health in Michigan: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Hetlioz Covered by Aetna CVS Health in Michigan Aetna CVS Health requires prior authorization for Hetlioz (tasimelteon) with strict criteria: total blindness for Non-24-Hour Sleep-Wake Disorder or genetic confirmation for Smith-Magenis Syndrome, failed melatonin trial, and specialist prescribing. If denied, you have 180 days to appeal internally,

Work With Your Doctor to Get Hetlioz (Tasimelteon) Approved by Aetna CVS Health in Ohio: Complete PA Guide

Answer Box: Getting Hetlioz Covered by Aetna CVS Health in Ohio Aetna CVS Health requires prior authorization for Hetlioz (tasimelteon) in Ohio for Non-24-hour sleep-wake disorder and Smith-Magenis syndrome. Fastest path to approval: Work with your sleep specialist to document your total blindness (for Non-24) or genetic confirmation (for SMS)

Myths vs. Facts: Getting Hetlioz (Tasimelteon) Covered by Humana in North Carolina

Answer Box: Getting Hetlioz Covered by Humana in North Carolina Hetlioz (tasimelteon) requires prior authorization from Humana and is often non-formulary, but coverage is possible with proper documentation. Key requirements: diagnosis of Non-24-hour sleep-wake disorder (typically requiring total blindness) or Smith-Magenis syndrome, specialist evaluation with sleep logs/actigraphy, and failed