Topic

Insurance Approval

A collection of 1411 issues

How to Get Ofev (nintedanib) Covered by Aetna CVS Health in California: Prior Authorization Guide and Appeals Process

Answer Box: Getting Ofev (nintedanib) Covered by Aetna CVS Health in California Ofev (nintedanib) is covered by Aetna CVS Health as a Tier 4 specialty drug with strict prior authorization requirements. You'll need HRCT showing ≥10% lung fibrosis, recent PFTs (FVC ≥45% predicted), and evidence of disease progression

How to Get Kuvan (Sapropterin) Covered by Aetna CVS Health in New Jersey: Complete Appeals Guide

Answer Box: Your Fastest Path to Kuvan Coverage Aetna CVS Health requires prior authorization for Kuvan (sapropterin) in New Jersey. Start by having your metabolic specialist submit a PA request through Aetna's Availity portal with complete PKU documentation, baseline phenylalanine levels, and dietary management records. If denied, you

How to Get Signifor LAR (Pasireotide) Covered by Cigna in Pennsylvania: Prior Authorization Requirements and Appeals Process

Quick Answer: Getting Cigna Coverage for Signifor LAR in Pennsylvania Cigna requires prior authorization for Signifor/Signifor LAR (pasireotide) with strict medical necessity criteria. Your endocrinologist must document: confirmed acromegaly or Cushing's disease diagnosis, elevated IGF-1/UFC levels, failed surgery or ineligibility, and trial/failure of first-generation somatostatin

Get Hemlibra (Emicizumab) Covered by Humana in New York: Complete Guide to Prior Authorization and Appeals

Answer Box: Quick Path to Hemlibra Coverage Hemlibra (emicizumab) requires prior authorization from Humana Medicare plans. To get approved in New York: 1) Have your hematologist submit a PA request with hemophilia A diagnosis, FVIII inhibitor test results, and treatment history to Humana at 877-486-2621. 2) If denied, request a

How to Get Breyanzi (lisocabtagene maraleucel) Covered by Cigna in Illinois: Complete Guide to Prior Authorization, Appeals, and State Resources

Answer Box: Getting Breyanzi Covered by Cigna in Illinois Fastest path to approval: Submit your prior authorization through CoverMyMeds or ExpressPAth with complete medical documentation showing refractory large B-cell lymphoma or CLL/SLL with transformation. First step today: Verify your plan covers specialty drugs through Express Scripts/Accredo, then gather

Getting Kesimpta (Ofatumumab) Covered by Blue Cross Blue Shield of North Carolina: Complete Prior Authorization and Appeal Guide

Quick Answer: Kesimpta requires prior authorization from Blue Cross Blue Shield of North Carolina and is typically placed in Tier 5 (specialty). Your doctor must document relapsing MS diagnosis, prior treatment failures, and complete HBV screening. If denied, you can appeal internally, then through North Carolina's Smart NC

How to Get Signifor LAR (Pasireotide) Covered by Aetna in Michigan: Prior Authorization Forms and Appeal Guide

Answer Box: Getting Signifor LAR Covered by Aetna in Michigan Aetna requires prior authorization for Signifor LAR (pasireotide) in Michigan. You must document trial and failure of Somatuline Depot (lanreotide) first, plus provide biochemical evidence (elevated UFC for Cushing's disease or IGF-1 for acromegaly). Submit via CVS Specialty

How to Get Rystiggo (Rozanolixizumab-noli) Covered by Blue Cross Blue Shield in Georgia: Forms, Appeals, and Success Strategies

Quick Answer: Getting Rystiggo Covered in Georgia Yes, Blue Cross Blue Shield Georgia covers Rystiggo (rozanolixizumab-noli) for generalized myasthenia gravis, but prior authorization is required. Your fastest path to approval: 1) Confirm your antibody status (AChR+ or MuSK+) with your neurologist, 2) Document failed standard therapies, and 3) Submit the

How to Get Photrexa (Riboflavin) Covered by Blue Cross Blue Shield in Ohio: Complete PA Guide and Appeal Timeline

Answer Box: Getting Photrexa Covered by Blue Cross Blue Shield in Ohio Blue Cross Blue Shield in Ohio covers Photrexa (riboflavin) for corneal cross-linking when you have documented progressive keratoconus and meet specific prior authorization requirements. The fastest path: 1) Gather corneal topography showing Kmax progression ≥1.0 diopter over

Work With Your Doctor to Get Eylea and Lucentis Covered by Cigna in North Carolina: Complete Appeals Guide

Answer Box: Getting Eylea/Lucentis Covered by Cigna in North Carolina Eligibility: Cigna covers Eylea (aflibercept) and Lucentis (ranibizumab) for wet AMD, diabetic macular edema, and other retinal conditions, but requires prior authorization and typically step therapy with bevacizumab first. Fastest Path: Your ophthalmologist submits a prior authorization through Cigna&