Topic

Insurance Approval

A collection of 2397 issues

How Long Does It Take to Get Ultomiris (ravulizumab) Approved by Humana in North Carolina? Complete Timeline Guide

Quick Answer: Humana typically approves complete Ultomiris prior authorizations within 1 business day for electronic submissions, but missing REMS enrollment or vaccination records can delay approval by weeks. Start by ensuring your prescriber is enrolled in the UltSolREMS program and you've received both MenACWY and MenB vaccines at

Do You Qualify for Brineura (Cerliponase Alfa) Coverage by Humana in Florida? Decision Tree & Next Steps

Answer Box: Your Path to Brineura Coverage Likely eligible if: Your child is ≥3 years old with confirmed CLN2 disease (both enzyme deficiency and genetic testing), has mild-to-moderate symptoms with some remaining motor and language function, and can receive treatment at a specialized center with intraventricular device placement capabilities. Fastest

Myths vs. Facts: Getting Gilenya (fingolimod) Covered by UnitedHealthcare in New York

Answer Box: Getting Gilenya Covered by UnitedHealthcare in New York Bottom line: UnitedHealthcare requires prior authorization and step therapy for Gilenya (fingolimod), but coverage is achievable with proper documentation. Most denials stem from missing baseline tests (EKG, eye exam), incomplete step therapy records, or inadequate medical necessity documentation. Fastest path:

How to Get Xywav (Ca/Mg/K/Na oxybates) Covered by UnitedHealthcare in Illinois: Complete Prior Authorization Guide

Quick Answer: Getting Xywav Covered in Illinois UnitedHealthcare requires prior authorization for Xywav with step therapy requirements. Your fastest path: 1) Enroll in the mandatory REMS program, 2) Document failed trials with preferred alternatives like Xyrem, 3) Submit complete OptumRx prior authorization form with sleep study results and ICD-10 codes

How to Get Aldurazyme (Laronidase) Covered by Blue Cross Blue Shield in North Carolina: Complete Appeals Guide with Forms and Deadlines

Answer Box: Getting Aldurazyme Covered by Blue Cross Blue Shield in North Carolina Aldurazyme (laronidase) requires prior authorization from Blue Cross Blue Shield of North Carolina. Success depends on documented MPS I diagnosis via enzymatic testing and genetic confirmation. If denied, you have 120 days to file an external review

How to Get Tysabri (Natalizumab) Covered by Humana in Pennsylvania: Appeals Guide with Templates

Quick Answer: Getting Tysabri Covered by Humana in Pennsylvania If Humana denied your Tysabri (natalizumab) coverage, you have options. First step: Ensure TOUCH program enrollment for both patient and prescriber—this is mandatory. Fastest path: Submit a formulary exception with medical necessity documentation showing failed DMTs and contraindications to alternatives.

How to Get Fintepla (fenfluramine) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Prior Authorization Guide

Answer Box: Getting Fintepla Covered by Blue Cross Blue Shield in Pennsylvania Blue Cross Blue Shield plans in Pennsylvania require prior authorization for Fintepla (fenfluramine) with specific REMS program enrollment and cardiac monitoring documentation. The fastest path to approval involves: (1) completing REMS enrollment with baseline echocardiogram, (2) documenting diagnosis

Get Voydeya (Danicopan) Approved by UnitedHealthcare in North Carolina: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Voydeya Covered by UnitedHealthcare in North Carolina Voydeya (danicopan) requires prior authorization from UnitedHealthcare for coverage as an add-on therapy to C5 inhibitors (eculizumab or ravulizumab) in adults with paroxysmal nocturnal hemoglobinuria (PNH) experiencing extravascular hemolysis. Your fastest path to approval: Have your hematologist submit a prior

How to Get Skyrizi (Risankizumab) Covered by UnitedHealthcare in Florida: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Skyrizi Covered by UnitedHealthcare in Florida Skyrizi (risankizumab) requires prior authorization from UnitedHealthcare in Florida. You'll need to document failure or intolerance to at least one TNF inhibitor (like Humira or Enbrel), provide specialty consultation notes, and submit disease severity measurements. The fastest path: have

How to Get Kalydeco (ivacaftor) Covered by Cigna in Virginia: Complete Prior Authorization Guide

Quick Answer: Getting Kalydeco (ivacaftor) Covered by Cigna in Virginia To get Kalydeco approved by Cigna in Virginia, you need: (1) documented CFTR mutation testing showing an eligible variant (not homozygous F508del), (2) cystic fibrosis diagnosis with ICD-10 code E84.0, and (3) prior authorization submission through Cigna's