Topic

Insurance Approval

A collection of 5310 issues

How to Get Pomalyst (Pomalidomide) Covered by Aetna (CVS Health) in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Pomalyst (Pomalidomide) Covered by Aetna (CVS Health) in Texas Aetna (CVS Health) requires prior authorization for Pomalyst (pomalidomide) with documented failure of both lenalidomide and a proteasome inhibitor, plus mandatory PS-Pomalidomide REMS enrollment. To get approval in Texas: (1) Complete REMS certification through the BMS portal within

How to Get Elevidys Covered by UnitedHealthcare in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Get Elevidys Covered by UnitedHealthcare in Ohio Elevidys (delandistrogene moxeparvovec-rokl) requires prior authorization from UnitedHealthcare OptumRx for DMD patients in Ohio. Key steps: 1) Submit PA with genetic confirmation, failed corticosteroid documentation, and anti-AAV antibody titers <1:400, 2) If denied, file internal appeal within 180 days,

Lowering Out-of-Pocket Costs for Enhertu with UnitedHealthcare in North Carolina: Copay Cards, Tiering Appeals, and Financial Assistance

Answer Box: Enhertu (fam-trastuzumab deruxtecan-nxki) costs $150,000+ annually but UnitedHealthcare commercial patients can reduce out-of-pocket to $0 drug cost plus $100/infusion using the ENHERTU4U copay program. Submit prior authorization via UnitedHealthcare Provider Portal with HER2-positive pathology results and prior therapy documentation. If denied, appeal internally within 180 days,

Myths vs. Facts: Getting Tavneos (Avacopan) Covered by Cigna in Virginia

Answer Box: Fast Track to Tavneos Coverage Getting Tavneos (avacopan) covered by Cigna in Virginia requires prior authorization for severe active ANCA-associated vasculitis (GPA/MPA) prescribed by a specialist and used with standard therapy like rituximab or cyclophosphamide. Cigna typically reviews requests within 72 hours (24 hours expedited). If denied,

A Realistic Epidiolex (Cannabidiol) Approval Scenario with Humana in Illinois (From Request to Yes)

Answer Box: Getting Epidiolex (Cannabidiol) Covered by Humana in Illinois Epidiolex requires prior authorization from Humana Medicare Advantage in Illinois for FDA-approved seizure disorders (LGS, Dravet syndrome, TSC). Submit via Humana provider portal with neurologist confirmation, failed antiseizure medication trials, EEG results, and seizure logs. Standard approval takes 14 days;

How Long Does It Take to Get Advate (octocog alfa) Approved by Blue Cross Blue Shield in North Carolina? Timeline & Milestones

Answer Box: Getting Advate Approved in North Carolina Blue Cross Blue Shield of North Carolina (BCBSNC) processes Advate (octocog alfa) prior authorization requests within 72 hours for standard reviews and 24 hours for urgent cases. The fastest path to approval requires complete documentation including factor VIII levels, inhibitor screening, bleeding

Myths vs. Facts: Getting Pomalyst (Pomalidomide) Covered by Aetna (CVS Health) in Illinois

Answer Box: Getting Pomalyst Covered by Aetna in Illinois Aetna (CVS Health) requires prior authorization for Pomalyst (pomalidomide) with documented failure of both lenalidomide and a proteasome inhibitor, plus mandatory REMS enrollment. Common myths include "doctor prescriptions guarantee coverage" and "appeals take months"—the reality is

How to Get Givlaari (Givosiran) Covered by UnitedHealthcare in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Givlaari Covered by UnitedHealthcare in Washington Givlaari (givosiran) requires prior authorization from UnitedHealthcare OptumRx, with potential step therapy requirements. Washington state law (RCW 48.43.420) provides strong protections for step therapy exceptions when medically necessary. First step: Have your specialist submit a prior authorization request with

How to Get Qalsody (Tofersen) Covered by Humana in New York: Appeals Guide with Forms and Timelines

Answer Box: Getting Qalsody Covered by Humana in New York Qalsody (tofersen) requires prior authorization from Humana for SOD1-mutated ALS patients. If denied, you have 65 days to appeal internally, then 4 months for New York's external review. Key requirements: confirmed SOD1 mutation, neurologist prescription, baseline ALSFRS-R score,

Renewing Uplizna (Inebilizumab) Coverage with Blue Cross Blue Shield in Florida: 2025 Requirements and Timeline

Answer Box: Renewing Your Uplizna Coverage in Florida Blue Cross Blue Shield Florida requires renewal documentation every 6-12 months for Uplizna (inebilizumab). Submit your renewal 30-45 days before current approval expires through your neurologist via the Availity portal or call 1-877-719-2583. Required documents: updated clinical notes showing treatment response, current