Topic

Insurance Approval

A collection of 2089 issues

Getting Entresto (Sacubitril/Valsartan) Covered by UnitedHealthcare in New Jersey: Complete Guide to Prior Authorization and Appeals

Quick Answer: UnitedHealthcare requires prior authorization for Entresto in New Jersey with specific criteria: heart failure diagnosis, LVEF ≤40% or structural heart disease, NYHA Class II-IV, cardiologist prescription, and discontinuation of ACE inhibitors/ARBs. Submit through the UnitedHealthcare provider portal or fax to 1-866-434-5523. If denied, you have 180 days

Getting Venclexta (venetoclax) Covered by Humana in New Jersey: Prior Authorization, Appeals, and Medical Necessity Guide

Answer Box: Fast Track to Venclexta Coverage To get Venclexta (venetoclax) covered by Humana in New Jersey: Your doctor must submit prior authorization with clinical documentation showing medical necessity, including diagnosis (CLL/AML), tumor lysis syndrome monitoring plan, and justification for why formulary alternatives won't work. Submit via

If Jynarque (Tolvaptan) Isn't Approved by Blue Cross Blue Shield in Pennsylvania: Formulary Alternatives & Exception Paths

Answer Box: Your Options When Jynarque Is Denied If Blue Cross Blue Shield Pennsylvania denies Jynarque (tolvaptan) for ADPKD, you have three paths: request a step therapy exception with documented rapid progression (Mayo class 1C-1E), try formulary alternatives like supportive therapies while building your case, or file an appeal through

Renewing Brineura (Cerliponase Alfa) Approval with Cigna in Virginia: 2025 Guide to Documentation, Timelines, and Appeals

Answer Box: Renewing Your Brineura Coverage with Cigna in Virginia Cigna typically authorizes Brineura (cerliponase alfa) for 6-month periods and requires comprehensive renewal documentation including updated clinical notes, device status reports, and evidence of ongoing benefit. Start your renewal application 30-60 days before expiration to avoid therapy gaps. Required documents

How to Get Natpara (Parathyroid Hormone) Covered by Aetna in Georgia: Complete Prior Authorization Guide

Answer Box: Getting Natpara Covered by Aetna in Georgia Critical Update: Takeda discontinued manufacturing Natpara globally at the end of 2024. No new commercial prescriptions are being filled—only existing Special Use Program patients continue to receive supply until December 31, 2025. If you're seeking Natpara coverage, work

Getting Mepsevii (Vestronidase Alfa) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Approval To get Mepsevii (vestronidase alfa-vjbk) covered by UnitedHealthcare in New Jersey: Submit prior authorization through OptumRx with complete MPS VII diagnostic proof (enzyme assay, genetic testing, elevated uGAGs) from a metabolic specialist. If denied, file internal appeal within 180 days, then external review through

How to Renew Ocrevus (Ocrelizumab) Coverage with Aetna CVS Health in Virginia: Timeline, Forms & Bridge Options

Answer Box: Renewing Ocrevus Coverage with Aetna CVS Health in Virginia To renew Ocrevus (ocrelizumab) with Aetna CVS Health in Virginia, submit your renewal request at least 2 weeks before your next scheduled infusion. You'll need updated clinical documentation showing disease stability or improvement, neurologist attestation, and confirmation

How to Get Vyondys 53 (Golodirsen) Covered by Aetna CVS Health in Illinois: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Vyondys 53 Covered by Aetna CVS Health in Illinois Fastest path to approval: Submit prior authorization with genetic testing confirming exon 53 mutation, baseline kidney function labs, and neuromuscular specialist oversight. If denied, request peer-to-peer review within days, then file internal appeal within 180 days. Illinois residents

How to Get Besponsa (Inotuzumab Ozogamicin) Covered by Humana in North Carolina: Complete Guide to Prior Authorization, Appeals, and Billing Codes

Answer Box: Getting Besponsa Covered by Humana in North Carolina Besponsa (inotuzumab ozogamicin) requires prior authorization through Evolent/New Century Health for all Humana Medicare Advantage plans. Submit requests via their portal at my.newcenturyhealth.com or call 844-926-4528 (option 5). Required documentation includes CD22-positive B-cell ALL diagnosis (ICD-10: C91.

How to Get Mavenclad (Cladribine) Covered by Humana in North Carolina: Complete Prior Authorization Guide

Answer Box: Your Path to Mavenclad Coverage Mavenclad (cladribine tablets) requires prior authorization from Humana and is subject to step therapy requirements. In North Carolina, you have 65 days to appeal denials through Humana's internal process, then 120 days to file external review with Smart NC. First step