Topic

Insurance Approval

A collection of 5257 issues

Lowering Out-of-Pocket for Signifor / Signifor LAR (pasireotide) with UnitedHealthcare in New Jersey: Copay, Tiering & Assistance

Quick Answer: Reducing Your Signifor LAR Costs with UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Signifor LAR (pasireotide) with potential high specialty tier costs. Key cost-reduction strategies include the manufacturer's $20 copay program for commercial insurance, foundation grants up to $13,600/year, and formulary tier

How to Get Gilenya (Fingolimod) Covered by Blue Cross Blue Shield in Washington: Prior Authorization Guide and Appeals Process

Answer Box: Getting Gilenya Covered in Washington Gilenya (fingolimod) requires prior authorization from Blue Cross Blue Shield plans in Washington. To get approved, you'll need baseline testing (EKG, eye exam, labs), documentation of MS diagnosis, and often proof that you've tried other therapies first. If denied,

How to Get Signifor / Signifor LAR (pasireotide) Covered by Cigna in Illinois: Prior Authorization, Appeals & Step Therapy Guide

Answer Box: Getting Signifor/Signifor LAR Covered by Cigna in Illinois Cigna requires prior authorization for all Signifor/Signifor LAR (pasireotide) prescriptions in Illinois. For acromegaly, you must first try octreotide or lanreotide; for Cushing's disease, document surgical failure or ineligibility. Your endocrinologist must submit detailed clinical evidence

Coding That Helps Get Elelyso (Taliglucerase Alfa) Approved in Washington with UnitedHealthcare: ICD-10, HCPCS J-Code, and Billing Guide

Answer Box: Fast Track to Elelyso Coverage Getting Elelyso (taliglucerase alfa) covered by UnitedHealthcare in Washington requires precise coding and documentation. Use ICD-10 code E75.22 for Gaucher disease, HCPCS J-code J3060 for billing (10 units per code), and calculate total dose ÷ 10 for billable units. Submit prior authorization through

How to Get Rebif (Interferon Beta-1a) Covered by Cigna in Washington: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Rebif Covered by Cigna in Washington Rebif (interferon beta-1a) requires prior authorization from Cigna, typically managed through Express Scripts/Accredo specialty pharmacy. The fastest path to approval: 1) Ensure your neurologist documents relapsing MS with proper ICD-10 codes (G35.A for RRMS, G35.C1 for active SPMS)

How to Get Aldurazyme (laronidase) Covered by Blue Cross Blue Shield in California: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Aldurazyme Coverage in California Blue Shield of California covers Aldurazyme (laronidase) as a specialty drug requiring prior authorization for MPS I patients. The fastest path to approval: (1) Gather genetic/enzymatic confirmation of MPS I diagnosis, (2) Document baseline disease severity and prior treatment failures, (3) Submit

How to Get Opsumit (Macitentan) Covered by Cigna in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Opsumit (Macitentan) Covered by Cigna in Texas Fastest path to approval: Have your PAH specialist submit a prior authorization request through Cigna's provider portal with documentation of your PAH diagnosis, functional class, prior therapy failures, and REMS enrollment. Timeline: 72 hours for standard review, 24

How to Get Rebif (Interferon Beta-1a) Covered by Cigna in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Rebif Covered by Cigna in Illinois Rebif (interferon beta-1a) requires prior authorization from Cigna and is subject to step therapy requirements. Treatment-naïve patients must first try dimethyl fumarate or fingolimod unless contraindicated. Your neurologist must document MS diagnosis with MRI activity, relapse history, and medical necessity. If

How to Get Ferriprox (Deferiprone) Covered by Humana in Michigan: Prior Authorization Guide and Appeals Process

Answer Box: Getting Ferriprox (Deferiprone) Covered by Humana in Michigan Fastest path to approval: Submit prior authorization with documented ANC ≥1.5 x 10⁹/L, weekly monitoring plan, and evidence of transfusional iron overload (ferritin >1000 ng/mL). If denied, you have 65 days to appeal internally, then 127

How to Get Alprolix Covered by UnitedHealthcare in New Jersey: PA Forms, Appeals, and State Resources

Answer Box: Getting Alprolix Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization (PA) for Alprolix through OptumRx, with coverage contingent on confirmed hemophilia B diagnosis, hematologist prescription, and documented failure of standard half-life factor IX therapy (≥50 exposure days). Submit PA via the UnitedHealthcare Provider Portal with medical