Topic

Insurance Approval

A collection of 603 issues

How to Get Oxbryta (Voxelotor) Covered by Cigna in New York: 2024 Withdrawal Update and Alternative Paths

Answer Box: Critical Update on Oxbryta (Voxelotor) Coverage Important: Oxbryta (voxelotor) was voluntarily withdrawn from the U.S. market by Pfizer in September 2024 due to safety concerns and insufficient clinical benefit. The drug is no longer FDA-approved and cannot be prescribed or covered by any U.S. insurer, including

How to Get Filsuvez (Birch Triterpenes Gel) Covered by Aetna CVS Health in Ohio: Appeals, Forms & State Protections

Answer Box: Getting Filsuvez Covered by Aetna CVS Health in Ohio Filsuvez (birch triterpenes gel) requires prior authorization from Aetna CVS Health in Ohio. To get coverage approved: 1) Have your dermatologist submit a prior authorization request with genetic testing confirming junctional or dystrophic epidermolysis bullosa, wound documentation showing partial-thickness

How to Get Jakafi (Ruxolitinib) Covered by Cigna in Florida: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Jakafi (Ruxolitinib) Covered by Cigna in Florida Jakafi (ruxolitinib) requires prior authorization through Cigna/Express Scripts for myelofibrosis and polycythemia vera. In Florida, you have 180 days to appeal denials internally, then 4 months for external review through the Florida Department of Financial Services. First step today:

How to Get Elevidys Covered by Blue Cross Blue Shield in California: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Elevidys Covered by Blue Cross Blue Shield in California Blue Shield of California requires prior authorization for Elevidys (delandistrogene moxeparvovec), the gene therapy for Duchenne Muscular Dystrophy. Key requirements: confirmed DMD genetic testing, ambulatory status (ages 4-5), stable corticosteroid regimen, and administration at a certified center. First

Getting Entresto (Sacubitril/Valsartan) Covered by UnitedHealthcare in New Jersey: Complete Guide to Prior Authorization and Appeals

Quick Answer: UnitedHealthcare requires prior authorization for Entresto in New Jersey with specific criteria: heart failure diagnosis, LVEF ≤40% or structural heart disease, NYHA Class II-IV, cardiologist prescription, and discontinuation of ACE inhibitors/ARBs. Submit through the UnitedHealthcare provider portal or fax to 1-866-434-5523. If denied, you have 180 days

Getting Venclexta (venetoclax) Covered by Humana in New Jersey: Prior Authorization, Appeals, and Medical Necessity Guide

Answer Box: Fast Track to Venclexta Coverage To get Venclexta (venetoclax) covered by Humana in New Jersey: Your doctor must submit prior authorization with clinical documentation showing medical necessity, including diagnosis (CLL/AML), tumor lysis syndrome monitoring plan, and justification for why formulary alternatives won't work. Submit via

If Jynarque (Tolvaptan) Isn't Approved by Blue Cross Blue Shield in Pennsylvania: Formulary Alternatives & Exception Paths

Answer Box: Your Options When Jynarque Is Denied If Blue Cross Blue Shield Pennsylvania denies Jynarque (tolvaptan) for ADPKD, you have three paths: request a step therapy exception with documented rapid progression (Mayo class 1C-1E), try formulary alternatives like supportive therapies while building your case, or file an appeal through

Renewing Brineura (Cerliponase Alfa) Approval with Cigna in Virginia: 2025 Guide to Documentation, Timelines, and Appeals

Answer Box: Renewing Your Brineura Coverage with Cigna in Virginia Cigna typically authorizes Brineura (cerliponase alfa) for 6-month periods and requires comprehensive renewal documentation including updated clinical notes, device status reports, and evidence of ongoing benefit. Start your renewal application 30-60 days before expiration to avoid therapy gaps. Required documents

How to Get Natpara (Parathyroid Hormone) Covered by Aetna in Georgia: Complete Prior Authorization Guide

Answer Box: Getting Natpara Covered by Aetna in Georgia Critical Update: Takeda discontinued manufacturing Natpara globally at the end of 2024. No new commercial prescriptions are being filled—only existing Special Use Program patients continue to receive supply until December 31, 2025. If you're seeking Natpara coverage, work

Getting Mepsevii (Vestronidase Alfa) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Approval To get Mepsevii (vestronidase alfa-vjbk) covered by UnitedHealthcare in New Jersey: Submit prior authorization through OptumRx with complete MPS VII diagnostic proof (enzyme assay, genetic testing, elevated uGAGs) from a metabolic specialist. If denied, file internal appeal within 180 days, then external review through