Topic

Insurance Approval

A collection of 5298 issues

Getting Mycapssa (Octreotide Oral) Approved by UnitedHealthcare in Georgia: Prior Authorization Guide and Appeals Process

Answer Box: How to Get Mycapssa Approved by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Mycapssa (oral octreotide) with step therapy mandating prior response to injectable octreotide or lanreotide. Submit your PA through OptumRx with acromegaly diagnosis (E22.0), documented injectable response, and medical necessity letter. If denied, you

How to Get Waylivra (volanesorsen) Covered by Humana in Illinois: Complete Guide with Forms, Appeals, and Assistance Programs

Answer Box: Getting Waylivra (volanesorsen) Covered by Humana in Illinois Waylivra (volanesorsen) requires prior authorization through Humana's formulary exception process since it's not FDA-approved in the US. Success depends on genetic confirmation of familial chylomicronemia syndrome (FCS), triglyceride levels >500 mg/dL despite standard therapies,

How to Get Kymriah (tisagenlecleucel) Covered by UnitedHealthcare in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Kymriah Covered by UnitedHealthcare in Virginia UnitedHealthcare covers Kymriah (tisagenlecleucel) under medical benefits as autologous stem cell therapy, requiring prior authorization through OptumHealth Transplant Solutions. For B-cell ALL (≤25 years) or relapsed/refractory DLBCL after ≥2 therapy lines, submit via the UHC Provider Portal with CD19+ confirmation,

Renewing Cabometyx (Cabozantinib) Coverage with Humana in Michigan: Complete Timeline and Documentation Guide

Answer Box: Renewing Cabometyx Coverage with Humana in Michigan Humana requires prior authorization renewal for Cabometyx (cabozantinib) before your current approval expires. Submit renewal requests at least 5-7 days early via Humana's provider portal or fax, including updated clinical documentation proving ongoing medical necessity. If denied, you have

How to Get Crysvita (Burosumab) Covered by Humana in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Crysvita (Burosumab) Covered by Humana in New York Crysvita (burosumab) requires prior authorization from Humana Medicare Advantage plans. To get approval: (1) Confirm your diagnosis of X-linked hypophosphatemia (XLH) with low serum phosphorus (<2.5-3.0 mg/dL) and PHEX gene testing, (2) Document failure or

How to Get Cometriq (cabozantinib) Covered by Cigna in Michigan: Complete PA and Appeals Guide

Answer Box: Getting Cometriq (cabozantinib) Covered by Cigna in Michigan Cometriq requires prior authorization through Cigna and must be dispensed through Accredo specialty pharmacy. Your oncologist submits clinical documentation proving medullary thyroid carcinoma (MTC) diagnosis with standard review completed within 72 hours. If denied, you have 180 days for internal

Work With Your Doctor to Get Acthar Gel Covered by Cigna in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box Getting Acthar Gel (repository corticotropin injection) covered by Cigna in North Carolina requires prior authorization approval before dispensing through Express Scripts' Accredo specialty pharmacy. Your fastest path: (1) Verify your diagnosis meets Cigna's approved conditions (infantile spasms, MS exacerbations, rheumatologic disorders), (2) Document corticosteroid failure/

How to Get Xembify (Immune Globulin SC) Covered by Florida Blue Cross Blue Shield: Prior Authorization, Appeals, and Alternative Options Guide

Quick Answer: Xembify (immune globulin SC) requires prior authorization from Florida Blue Cross Blue Shield for primary immunodeficiency. Submit PA 60-75 days before needed with diagnosis labs (low IgG), infection history, and failed IVIG/SCIG trials. If denied, you have 180 days to appeal internally, then external review through Florida

How to Get Pomalyst (Pomalidomide) Covered by Aetna (CVS Health) in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Pomalyst (Pomalidomide) Covered by Aetna (CVS Health) in Texas Aetna (CVS Health) requires prior authorization for Pomalyst (pomalidomide) with documented failure of both lenalidomide and a proteasome inhibitor, plus mandatory PS-Pomalidomide REMS enrollment. To get approval in Texas: (1) Complete REMS certification through the BMS portal within

How to Get Elevidys Covered by UnitedHealthcare in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Get Elevidys Covered by UnitedHealthcare in Ohio Elevidys (delandistrogene moxeparvovec-rokl) requires prior authorization from UnitedHealthcare OptumRx for DMD patients in Ohio. Key steps: 1) Submit PA with genetic confirmation, failed corticosteroid documentation, and anti-AAV antibody titers <1:400, 2) If denied, file internal appeal within 180 days,