Topic

Insurance Approval

A collection of 2105 issues

Get Haegarda (C1-Esterase Inhibitor) Covered by Aetna CVS Health in Ohio: Complete Guide with Forms & Appeals

Answer Box: Getting Haegarda Covered by Aetna in Ohio You likely qualify for Haegarda coverage if you have: confirmed HAE with low C1-INH function/protein levels, specialist consultation, and documented attack frequency requiring prophylaxis. Fastest path: Have your HAE specialist submit prior authorization with lab results (C4, C1-INH functional/antigenic)

How to Get Onpattro (patisiran) Covered by Cigna in Michigan: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Onpattro (patisiran) Covered by Cigna in Michigan Eligibility: Adults with hereditary transthyretin-mediated amyloidosis (hATTR) with polyneuropathy, confirmed by genetic testing showing a pathogenic TTR variant. Fastest path: Submit prior authorization with neurologist evaluation, genetic test results, and clinical documentation via Cigna's provider portal. Start today:

How to Get Oxbryta (Voxelotor) Covered by Cigna in New York: 2024 Withdrawal Update and Alternative Paths

Answer Box: Critical Update on Oxbryta (Voxelotor) Coverage Important: Oxbryta (voxelotor) was voluntarily withdrawn from the U.S. market by Pfizer in September 2024 due to safety concerns and insufficient clinical benefit. The drug is no longer FDA-approved and cannot be prescribed or covered by any U.S. insurer, including

How to Get Filsuvez (Birch Triterpenes Gel) Covered by Aetna CVS Health in Ohio: Appeals, Forms & State Protections

Answer Box: Getting Filsuvez Covered by Aetna CVS Health in Ohio Filsuvez (birch triterpenes gel) requires prior authorization from Aetna CVS Health in Ohio. To get coverage approved: 1) Have your dermatologist submit a prior authorization request with genetic testing confirming junctional or dystrophic epidermolysis bullosa, wound documentation showing partial-thickness

How to Get Jakafi (Ruxolitinib) Covered by Cigna in Florida: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Jakafi (Ruxolitinib) Covered by Cigna in Florida Jakafi (ruxolitinib) requires prior authorization through Cigna/Express Scripts for myelofibrosis and polycythemia vera. In Florida, you have 180 days to appeal denials internally, then 4 months for external review through the Florida Department of Financial Services. First step today:

How to Get Elevidys Covered by Blue Cross Blue Shield in California: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Elevidys Covered by Blue Cross Blue Shield in California Blue Shield of California requires prior authorization for Elevidys (delandistrogene moxeparvovec), the gene therapy for Duchenne Muscular Dystrophy. Key requirements: confirmed DMD genetic testing, ambulatory status (ages 4-5), stable corticosteroid regimen, and administration at a certified center. First

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