Topic

Insurance Approval

A collection of 1184 issues

Renewing Fintepla (Fenfluramine) Coverage with Aetna CVS Health in Michigan: Documentation Guide and Timeline

Answer Box: Fintepla (fenfluramine) renewal with Aetna CVS Health in Michigan requires documented seizure frequency reduction, current echocardiogram results, and REMS compliance. Start renewal process 60 days before current authorization expires. Submit seizure logs, cardiac monitoring results, and prescriber attestation through Aetna's provider portal or CVS Caremark. Most

How to Get Keytruda (pembrolizumab) Covered by Blue Cross Blue Shield in New Jersey: Forms, Appeals, and Provider Collaboration Guide

Answer Box: Getting Keytruda Covered in New Jersey Blue Cross Blue Shield requires prior authorization for Keytruda (pembrolizumab) in New Jersey. The fastest path: Submit a complete PA request with diagnosis, PD-L1 testing results (when required), and prior treatment documentation. If denied, you have 60 days to file an external

Myths vs. Facts: Getting Keppra (Levetiracetam) Covered by Blue Cross Blue Shield in North Carolina

Answer Box: Keppra Coverage by Blue Cross Blue Shield in North Carolina Good news: Generic levetiracetam (Keppra) is covered on Blue Cross NC's 2024 formularies without prior authorization. Brand-name Keppra requires medical necessity documentation showing generic failure or intolerance. If denied, appeal internally first, then request external review

How to Get Myozyme (Alglucosidase Alfa) Covered by Cigna in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Myozyme Covered by Cigna in Washington Cigna covers Myozyme (alglucosidase alfa) for confirmed Pompe disease with prior authorization. The fastest path: (1) Ensure your prescriber is a metabolic specialist or geneticist, (2) Submit complete diagnostic confirmation (GAA enzyme deficiency or genetic testing) with Cigna's PA

Myths vs. Facts: Getting Xywav (Ca/Mg/K/Na oxybates) Covered by Humana in Illinois

Quick Answer: Getting Xywav Covered by Humana in Illinois Myth: If your doctor prescribes Xywav, Humana automatically covers it. Fact: Xywav requires prior authorization with specific documentation. In Illinois, you have strong appeal rights if denied—including external review within 30 days. First step: ensure your prescriber enrolls in the

If Brensocatib (BRINSUPRI) Isn't Approved by Humana in Ohio: Formulary Alternatives & Exception Paths

Answer Box: When Humana Denies Brensocatib (BRINSUPRI) in Ohio If Humana denies coverage for Brensocatib (BRINSUPRI) in Ohio, you have three main options: try formulary alternatives like macrolide antibiotics first (often required by step therapy), request a formulary exception with clinical documentation, or pursue an internal appeal followed by Ohio&

Get Xyrem (Sodium Oxybate) Covered by Humana in Texas: Complete Guide to Forms, Appeals & Approvals

Quick Start: Your Path to Xyrem Coverage Xyrem (sodium oxybate) requires prior authorization from Humana Medicare Advantage plans in Texas. The fastest path to approval: have your doctor submit the Medicare Part D prior authorization form with clinical documentation to 877-486-2621, while simultaneously enrolling in the mandatory XYREM REMS program

Get Fintepla (Fenfluramine) Covered by Blue Cross Blue Shield in North Carolina: Complete Guide

Answer Box: Getting Fintepla Approved by BCBS North Carolina Fintepla (fenfluramine) is covered by Blue Cross Blue Shield North Carolina but requires prior authorization and REMS enrollment. Here's your fastest path to approval: 1. Enroll in REMS program - Both patient and prescriber must complete enrollment at FinteplarREMS.

How to Get Ibrance (Palbociclib) Covered by Humana in Washington: Appeals Process, Forms, and State Protections

Answer Box: Getting Ibrance (Palbociclib) Covered by Humana in Washington Fastest path to approval: Submit prior authorization with HR+/HER2- pathology reports, combination therapy documentation (aromatase inhibitor or fulvestrant), and oncologist's medical necessity letter. If denied, you have 65 days to appeal and can request Washington's

How to Get Ibrance (Palbociclib) Covered by Humana in New York: Prior Authorization, Appeals & Financial Aid

Answer Box: Getting Ibrance (Palbociclib) Covered by Humana in New York Ibrance (palbociclib) requires prior authorization from Humana and is classified as a Tier 5 specialty drug with copays ranging from $168-$764 per month. Your fastest path to approval: 1. Have your oncologist submit prior authorization with HR+/HER2-