Topic

Insurance Approval

A collection of 2352 issues

How to Get Evkeeza (Evinacumab-dgnb) Covered by Cigna in New Jersey: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Evkeeza Covered by Cigna in New Jersey Evkeeza (evinacumab-dgnb) requires strict prior authorization from Cigna for homozygous familial hypercholesterolemia (HoFH). New Jersey law mandates 72-hour response times for non-urgent requests and 24-hour for urgent cases. First step: Have your specialist submit the Cigna PA form with genetic
7 min read

How to Get Dupixent (Dupilumab) Covered by Aetna CVS Health in New Jersey: Complete Guide to Prior Authorization, Appeals, and Approval

Answer Box: Getting Dupixent Covered by Aetna CVS Health in New Jersey Dupixent (dupilumab) is covered by Aetna CVS Health for FDA-approved conditions but requires prior authorization. Success depends on documenting failed conventional therapies and meeting specific clinical criteria. Your fastest path: 1) Have your specialist submit a complete PA
6 min read

The Requirements Checklist to Get Rylaze (Asparaginase Erwinia Chrysanthemi) Covered by Aetna CVS Health in Ohio

Answer Box: Fast Track to Rylaze Coverage Eligibility: Patients with ALL/LBL who developed hypersensitivity to E. coli-derived asparaginase. Fastest path: Submit Aetna's specialty drug prior authorization form via fax (1-888-267-3277) with documented hypersensitivity reaction and oncologist letter. First step today: Gather your hypersensitivity documentation and complete clinical
6 min read

Crysvita (Burosumab) Approval with UnitedHealthcare in New York: Complete Guide to Prior Authorization, Appeals, and Coverage

Answer Box: Getting Crysvita Covered by UnitedHealthcare in New York UnitedHealthcare covers Crysvita (burosumab) for X-linked hypophosphatemia (XLH) and tumor-induced osteomalacia (TIO) with prior authorization in New York. Key requirements include confirmed diagnosis via genetic testing or elevated FGF23, specialist prescribing, and documented clinical need. First step today: Contact your
6 min read

Do You Qualify for Stelara (Ustekinumab) Coverage by UnitedHealthcare in Virginia? Decision Tree & Next Steps

Answer Box: Getting Stelara Covered by UnitedHealthcare in Virginia Quick Answer: UnitedHealthcare now prefers biosimilars (Steqeyma, Yesintek) over brand Stelara as of September 2024. To qualify for Stelara coverage, you'll need prior authorization showing medical necessity and documented failure/intolerance to preferred alternatives. First step: Have your doctor
5 min read

How to Get Mycapssa (Octreotide Oral) Covered by Aetna CVS Health in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Mycapssa Covered by Aetna CVS Health in New York Eligibility: Mycapssa (octreotide oral) requires prior authorization from Aetna CVS Health for acromegaly patients who previously responded to injectable octreotide or lanreotide. Fastest path: Have your endocrinologist submit a PA request through the Availity provider portal with documented
6 min read

How to Get Arcalyst (rilonacept) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Arcalyst Covered by Blue Cross Blue Shield in Pennsylvania Blue Cross Blue Shield requires prior authorization for Arcalyst (rilonacept) in Pennsylvania for all FDA-approved indications. The fastest path to approval: 1) Have your prescriber submit a complete PA request with diagnosis (CAPS, DIRA, or recurrent pericarditis), ICD-10
6 min read

How to Get Pemazyre (Pemigatinib) Covered by Aetna CVS Health in Washington: Appeals, Forms & Timelines

Answer Box: Getting Pemazyre Covered by Aetna CVS Health in Washington Pemazyre (pemigatinib) requires prior authorization from Aetna CVS Health and is typically non-formulary, requiring a formulary exception. Key requirements: FDA-approved test confirming FGFR2 fusion/rearrangement, previous systemic therapy failure, and comprehensive clinical documentation. First step: Have your oncologist submit
6 min read