Topic

Insurance Approval

A collection of 6352 issues

Get Cabometyx (Cabozantinib) Covered by Aetna in Michigan: Complete PA Guide and Appeals Process

Answer Box: Getting Cabometyx Covered by Aetna in Michigan Cabometyx (cabozantinib) requires prior authorization from Aetna CVS Health for all FDA-approved cancer indications in Michigan. The fastest path to approval: (1) Submit complete PA documentation through your oncologist including prior therapy failures and recent imaging, (2) Use Aetna's

How to Get Epidiolex (Cannabidiol) Covered by Blue Cross Blue Shield in Washington: Complete 2025 Guide

Quick Answer: Getting Epidiolex Covered in Washington Epidiolex (cannabidiol) requires prior authorization from Blue Cross Blue Shield plans in Washington, including Premera and Regence. You'll need confirmed diagnosis of Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex seizures, plus documented failure of at least 2 generic anti-seizure medications.

How to Get Cimzia (Certolizumab Pegol) Covered by Humana in Ohio: PA Forms, Appeals Timeline & Scripts

Answer Box: Getting Cimzia Covered by Humana in Ohio Cimzia (certolizumab pegol) requires prior authorization from Humana in Ohio. The fastest path to approval: (1) Your prescriber submits a PA request via Humana's provider portal with documentation of failed TNF inhibitors and TB/hepatitis B screening, (2) If

Galafold (Migalastat) Approval with UnitedHealthcare in Washington: Answers to the Most Common Questions

Answer Box: Getting Galafold Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Galafold (migalastat) with proof of Fabry disease diagnosis and an amenable GLA variant confirmed by in vitro assay. Initial approval lasts 12 months; reauthorization requires documented positive clinical response. If denied, Washington residents can appeal through

How to Get Zolgensma (onasemnogene abeparvovec) Covered by Humana in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by Humana in New Jersey Zolgensma (onasemnogene abeparvovec) requires prior authorization from Humana Medicare Advantage plans. Key requirements include genetic confirmation of SMA with SMN1 mutation, patient under 2 years old, negative AAV9 antibodies, and prescription by a pediatric neurologist at a certified gene therapy

UnitedHealthcare's Coverage Criteria for Increlex (Mecasermin) in Georgia: What Counts as "Medically Necessary"?

Answer Box: Getting Increlex Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Increlex (mecasermin) through OptumRx for pediatric patients with severe primary IGF-1 deficiency. Key criteria: height ≤ -3.0 standard deviation scores, IGF-1 levels ≤ -3.0 SDS, normal/elevated growth hormone levels, and pediatric endocrinologist prescription. If denied,

How to Get Evrysdi (Risdiplam) Covered by Cigna in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Evrysdi Covered by Cigna in California Yes, Cigna covers Evrysdi (risdiplam) with prior authorization. You need genetic confirmation of SMA (SMN1 mutations), baseline motor assessment scores, and prescription by a neuromuscular specialist. Fastest path: Have your neurologist submit the completed Cigna Evrysdi PA form with genetic test

How to Get Alprolix Covered by Aetna CVS Health in Texas: Complete PA Guide with Appeals Process

Answer Box: Getting Alprolix Covered by Aetna CVS Health in Texas Alprolix is excluded from Aetna's 2024 formularies, requiring a coverage exception for hemophilia B patients in Texas. Submit a prescriber-initiated exception request with documented factor IX deficiency ≤2%, bleeding history, and failed alternatives. Aetna must respond within

Myths vs. Facts: Getting Hemgenix (Etranacogene Dezaparvovec) Covered by Cigna in New York

Answer Box: Getting Hemgenix Covered by Cigna in New York Eligibility: Male patients ≥18 with severe hemophilia B (Factor IX ≤2%), ≥150 exposure days, negative AAV5 antibodies, and normal liver function qualify for Cigna coverage under policy IP_0535. Fastest path: Submit prior authorization with complete lab documentation (Factor IX

How to Get Elaprase (Idursulfase) Covered by Humana in Georgia: Prior Authorization Guide with Appeal Scripts

Answer Box: Getting Elaprase (Idursulfase) Covered by Humana in Georgia Humana requires prior authorization for Elaprase (idursulfase), a specialty enzyme replacement therapy for Hunter syndrome (MPS II). To get approval in Georgia: 1. Confirm diagnosis with enzymatic testing (reduced iduronate-2-sulfatase activity) or genetic testing 2. Submit PA request via Humana