Topic

Insurance Approval

A collection of 2360 issues

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

How to Get Palynziq (pegvaliase-pqpz) Covered by Cigna in Washington: Complete Guide with Forms and Appeal Scripts

Answer Box: To get Palynziq (pegvaliase-pqpz) covered by Cigna in Washington, you need: (1) PKU diagnosis with blood phenylalanine >600 µmol/L despite current management, (2) prescription from a metabolic specialist, and (3) prior authorization showing you're not using sapropterin concurrently. Submit via Cigna's provider

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

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

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

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

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

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

How to Get Waylivra (Volanesorsen) Covered by Humana in Georgia: Forms, Appeals, and Success Strategies

Quick Answer: Getting Waylivra Covered by Humana in Georgia Waylivra (volanesorsen) requires prior authorization from Humana for familial chylomicronemia syndrome (FCS). The fastest path: 1) Confirm your FCS diagnosis meets criteria (persistent triglycerides ≥880 mg/dL, genetic testing), 2) Submit Humana's PA form via fax (502-508-9300) or phone

How Long Does It Take to Get Vyndaqel / Vyndamax (tafamidis) Approved by Humana in New York? Complete Timeline Guide

Quick Answer: Vyndaqel / Vyndamax Approval Timeline with Humana Standard approval: 30 days from complete submission. Expedited review: 72 hours if medically urgent. Key requirements: Confirmed ATTR-CM diagnosis (PYP scan or biopsy), NYHA Class I-III, cardiology oversight. Fastest path: Submit complete PA packet with diagnostic imaging, specialist letter, and prior therapy