Topic

Insurance Approval

A collection of 1200 issues

Work With Your Doctor to Get Orladeyo (Berotralstat) Approved by UnitedHealthcare in Georgia: Forms, Appeal Scripts, and Clinical Documentation Guide

Answer Box: Getting Orladeyo Covered by UnitedHealthcare in Georgia Orladeyo (berotralstat) requires prior authorization from UnitedHealthcare with step therapy documentation showing failure or contraindication to first-line HAE prophylaxis treatments. Your allergist/immunologist must submit a medical necessity letter proving ≥1 moderate-to-severe HAE attack monthly and that alternatives like Cinryze or

How to Get Zanzalintinib (XL092) Covered by Cigna in Illinois: Coding, Appeals, and Investigational Drug Access

Answer Box: Getting Zanzalintinib (XL092) Covered by Cigna in Illinois Zanzalintinib (XL092) is an investigational drug that Cigna typically doesn't cover outside clinical trials. However, Illinois patients have strong appeal rights. Your fastest path: 1) Submit a formulary exception request with detailed medical necessity documentation, 2) If denied,

Get Strensiq (Asfotase Alfa) Approved by Aetna CVS Health in Ohio: Complete Coverage Guide

Answer Box: Quick Start Guide Yes, Aetna CVS Health covers Strensiq (asfotase alfa) for hypophosphatasia in Ohio with prior authorization. You need documented perinatal/infantile or juvenile-onset HPP with genetic confirmation (ALPL mutation) or biochemical proof (low alkaline phosphatase + elevated substrates + skeletal abnormalities). Your doctor submits the precertification request to

How to Get Alecensa (alectinib) Covered by Cigna in North Carolina: Complete Appeals Guide

Answer Box: Getting Alecensa (alectinib) Covered by Cigna in North Carolina Eligibility: Cigna covers Alecensa for ALK-positive non-small cell lung cancer with prior authorization. Fastest approval path: Submit PA with ALK test results, diagnosis codes, and clinical notes through CoverMyMeds or fax to 1-866-873-8279. First step today: Gather your ALK

How to Get Alecensa (alectinib) Covered by UnitedHealthcare in New Jersey: 2025 Step Therapy Rules, Appeals Process, and Timeline Requirements

Answer Box: Getting Alecensa Covered in New Jersey New Jersey's 2025 laws give you stronger protections for getting Alecensa (alectinib) approved by UnitedHealthcare. Starting January 1, 2026, state-regulated plans must grant step therapy exceptions within 24-72 hours if prior ALK inhibitors caused harm, were ineffective, or you'

Complete Guide: Getting Uplizna (Inebilizumab) Covered by Blue Cross Blue Shield in Washington State

Answer Box: Fastest Path to Uplizna Coverage in Washington Who qualifies: Adults with AQP4-positive NMOSD or IgG4-related disease. Step 1: Confirm your Blue Cross Blue Shield plan requires prior authorization (most do). Step 2: Your neurologist submits a PA request with AQP4-IgG test results, diagnosis documentation, and failed therapy history.

Work With Your Doctor to Get Soliris (Eculizumab) Covered by Cigna in Michigan: Appeal Forms and Clinical Evidence Guide

Quick Answer: Getting Soliris (Eculizumab) Covered by Cigna in Michigan Eligibility: Soliris requires prior authorization through Cigna's specialty pharmacy (Accredo/Express Scripts) for FDA-approved conditions: PNH, atypical HUS, generalized myasthenia gravis, and NMOSD. Key requirements: meningococcal vaccination ≥2 weeks before treatment, confirmed diagnosis with specific lab tests, and

How to Renew Fintepla (Fenfluramine) Coverage with Cigna in North Carolina: 2025 Requirements & Timelines

Answer Box: Renewing Fintepla Coverage with Cigna in North Carolina Cigna requires annual prior authorization renewal for Fintepla (fenfluramine) with mandatory REMS compliance and echocardiography documentation. Start your renewal 60-90 days before expiration. You'll need: current REMS enrollment, echocardiogram results (required every 6 months), seizure frequency logs showing

How to Get Firazyr (Icatibant) Covered by Blue Cross Blue Shield in Ohio: Complete Guide with Forms and Appeals Process

Quick Answer: Getting Firazyr Covered by BCBS Ohio Blue Cross Blue Shield Ohio requires prior authorization for Firazyr (icatibant) for hereditary angioedema (HAE) treatment. Start today by: 1) Confirming your HAE diagnosis documentation with an immunologist/allergist, 2) Having your doctor submit the PA request through Anthem's provider

How to Get Cystadane (Betaine Anhydrous) Covered by Cigna in Illinois: Appeals Guide with Forms and Timelines

Answer Box: Getting Cystadane Covered by Cigna in Illinois Cigna requires prior authorization for Cystadane (betaine anhydrous) for homocystinuria treatment. To get approval: (1) Have your specialist submit genetic/biochemical proof of homocystinuria diagnosis, (2) Document failed or contraindicated vitamin therapies (B6, B12, folate), and (3) Include specialist oversight confirmation.