Topic

Insurance Approval

A collection of 2376 issues

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

Work With Your Doctor to Get Isturisa (Osilodrostat) Approved by Blue Cross Blue Shield in Georgia: Complete Guide

Quick Answer: Getting Isturisa Covered by BCBS Georgia Fastest path: Work with your endocrinologist to submit a comprehensive prior authorization request including confirmed Cushing's disease diagnosis (abnormal UFC or salivary cortisol tests), documentation of surgical contraindication, and detailed medical necessity letter. If denied, you have 60 days to

Get Firdapse (Amifampridine) Covered by Cigna in Washington: Complete Prior Authorization Guide

Quick Answer: Getting Firdapse Covered by Cigna in Washington To get Firdapse (amifampridine) covered by Cigna in Washington, you need: (1) confirmed LEMS diagnosis with positive antibody testing or EMG, (2) prescription from a neurologist/neuromuscular specialist, (3) no seizure history, and (4) prior authorization submission. If denied, Washington'

How to Get Evkeeza (evinacumab-dgnb) Covered by Blue Cross Blue Shield Michigan: Appeals Guide & Forms

Quick Answer: Getting Evkeeza Covered by Blue Cross Blue Shield Michigan To get Evkeeza (evinacumab-dgnb) covered by BCBS Michigan for homozygous familial hypercholesterolemia (HoFH), you'll need prior authorization with genetic testing confirmation, documented LDL-C levels ≥400 mg/dL, and evidence of inadequate response to maximum tolerated lipid-lowering therapies.

How to Get Thiola / Thiola EC (tiopronin) Covered by UnitedHealthcare in Texas: Prior Authorization, Appeals, and Billing Guide

Quick Answer: UnitedHealthcare requires prior authorization for Thiola/Thiola EC (tiopronin) with step therapy requirements in Texas. Success requires documenting cystinuria diagnosis (ICD-10: E72.01), failed conservative therapy, and specialist evaluation. If denied, Texas law provides internal appeals (180 days) and binding external review through Independent Review Organizations (IROs). Start