Topic

Insurance Approval

A collection of 3076 issues

Myths vs. Facts: Getting Isturisa (Osilodrostat) Covered by Cigna in Georgia

Quick Answer: Isturisa (osilodrostat) coverage by Cigna in Georgia requires prior authorization with endocrinologist prescription, confirmed Cushing's disease diagnosis, and surgical contraindication documentation. If denied, you have 180 days for internal appeals and 60 days for Georgia Department of Insurance external review. Start by contacting your endocrinologist to

Myths vs. Facts: Getting Voydeya (danicopan) Covered by Aetna CVS Health in North Carolina

Answer Box: Getting Voydeya (danicopan) Covered by Aetna CVS Health in North Carolina Eligibility: Voydeya requires prior authorization from Aetna CVS Health with documented PNH diagnosis via flow cytometry, evidence of extravascular hemolysis on C5 inhibitor therapy, and specialist prescriber attestation. Fastest path: Have your hematologist submit complete PA documentation

How to Get Rebif (interferon beta-1a) Covered by Aetna in Washington: Appeals Guide with Forms & Timelines

Answer Box: Getting Rebif Covered by Aetna in Washington Aetna requires prior authorization for Rebif (interferon beta-1a) and often places it on non-preferred tiers with step therapy requirements. To get coverage approved in Washington: 1. Submit comprehensive PA documentation including MS diagnosis, MRI evidence of activity, and prior treatment failures

How to Get Trikafta Covered by Blue Cross Blue Shield Georgia: Prior Authorization Forms, Appeals, and Success Strategies

Answer Box: Getting Trikafta Covered by BCBS Georgia Trikafta requires prior authorization from Blue Cross Blue Shield Georgia. Your fastest path: (1) Submit PA through Availity portal with CFTR genotype documentation and CF diagnosis, (2) Use specialty pharmacy network, (3) If denied, file internal appeal within plan deadlines, then external

How to Get Gilenya (Fingolimod) Covered by Blue Cross Blue Shield of Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Gilenya Covered in Michigan Blue Cross Blue Shield of Michigan (BCBSM) requires prior authorization for Gilenya (fingolimod), typically with step therapy requirements. Your fastest path to approval: (1) Document failed first-line MS therapies like interferon beta or Copaxone, (2) Submit PA via CoverMyMeds with complete EKG monitoring

Get Evkeeza (Evinacumab) Covered by UnitedHealthcare in Pennsylvania: Step-by-Step Approval Guide

Quick Answer: Getting Evkeeza Covered in Pennsylvania To get Evkeeza (evinacumab) approved by UnitedHealthcare in Pennsylvania, you need: confirmed HoFH diagnosis with LDL-C >400 mg/dL, documented failures of maximum-tolerated statins/ezetimibe/PCSK9 inhibitors, and prior authorization through the UnitedHealthcare Provider Portal. If denied, Pennsylvania's new external

Getting Luxturna (Voretigene Neparvovec) Covered by Aetna CVS Health in North Carolina: Complete Guide

Answer Box: Getting Luxturna Covered in North Carolina Eligibility: Aetna CVS Health covers Luxturna (voretigene neparvovec) for patients with confirmed biallelic RPE65 mutations causing retinal dystrophy. Prior authorization is required for all plans. Fastest path: 1) Obtain genetic testing confirming RPE65 mutations, 2) Submit comprehensive PA request with clinical documentation

How to Get Sumavel DosePro Covered by Cigna in New Jersey: Complete Appeals Guide and Alternative Options

Quick Answer: Sumavel DosePro Coverage with Cigna in New Jersey Important Update: Sumavel DosePro (needle-free sumatriptan injection) was discontinued in the United States in 2018 and is no longer available on any formulary, including Cigna's. However, generic sumatriptan injection remains covered by Cigna with prior authorization. Your fastest

How to Get Firdapse (Amifampridine) Covered by Humana in Michigan: Complete Guide to Prior Authorization and Appeals

Quick Answer: Firdapse (amifampridine) requires prior authorization from Humana Medicare Advantage/Part D in Michigan. You'll need confirmed LEMS diagnosis by a neuromuscular specialist, EMG results showing >60% CMAP increment, VGCC antibody testing, and cancer screening. Submit through Humana's provider portal with complete clinical documentation.

How Long Does It Take to Get Vitrakvi (Larotrectinib) Approved by Humana in Virginia? Complete Timeline Guide

Answer Box: Vitrakvi (Larotrectinib) Approval Timeline Standard timeline: Humana processes Vitrakvi (larotrectinib) prior authorization requests within 72 hours for standard cases, 24 hours for expedited requests in Virginia. Success depends on complete NTRK fusion testing documentation and medical necessity evidence. Fastest path to approval: 1. Gather validated NTRK gene fusion