Topic

Insurance Approval

A collection of 5314 issues

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

Advate (Octocog Alfa) Approval with Blue Cross Blue Shield in New York: Answers to the Most Common Questions

Answer Box: Getting Advate Covered by Blue Cross Blue Shield in New York Yes, Blue Cross Blue Shield covers Advate (octocog alfa) for hemophilia A in New York, but prior authorization is required. Your hematologist must submit PA documentation including Factor VIII levels, inhibitor testing, and clinical justification. If denied,

How to Get Amvuttra (Vutrisiran) Covered by UnitedHealthcare in Washington: Complete Guide to Prior Authorization, Appeals, and External Review

Answer Box: Getting Amvuttra Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Amvuttra (vutrisiran) in Washington. Submit documentation including TTR genetic testing, specialist evaluation, and baseline outcomes via OptumRx PreCheck Prior Authorization or call 1-800-711-4555. If denied, appeal within 65 days internally, then request external review through Washington&

If Tagrisso (Osimertinib) Isn't Approved by Blue Cross Blue Shield in Michigan: Formulary Alternatives & Exception Paths

Answer Box: Getting Tagrisso Alternatives or Exceptions with BCBS Michigan If BCBS Michigan denies Tagrisso (osimertinib), you have three main paths: try formulary alternatives like erlotinib or gefitinib with prior authorization, request a formulary exception for Tagrisso with medical necessity documentation, or appeal the denial through Michigan's external

Work With Your Doctor to Get Opdivo (nivolumab) Approved by UnitedHealthcare in Ohio: Complete Provider Collaboration Guide

Answer Box: Your Path to Opdivo Approval Getting Opdivo (nivolumab) covered by UnitedHealthcare in Ohio requires prior authorization with specific biomarker testing and clinical documentation. Work with your oncologist to submit evidence through UnitedHealthcare's provider portal, request peer-to-peer review if denied (~85% overturn rate), and use Ohio'

Lowering Out-of-Pocket Costs for Adynovate (bdanocog alfa pegol) with Aetna CVS Health in Texas: Copay Cards, Tiering & Appeals

Answer Box: Fast Track to Affordable Adynovate Coverage Aetna CVS Health covers Adynovate (bdanocog alfa pegol) as a preferred specialty drug for hemophilia A, requiring prior authorization with hematologist prescription and clinical documentation. Texas patients can reduce costs through Takeda's copay card (covers up to 100% of out-of-pocket

Myths vs. Facts: Getting Fabrazyme (Agalsidase Beta) Covered by Cigna in California

Quick Answer: Fabrazyme Coverage by Cigna in California Yes, Cigna covers Fabrazyme (agalsidase beta) for Fabry disease in California, but requires prior authorization (PA) with genetic/biochemical confirmation and specialist prescriber. After internal appeals, California's Department of Managed Health Care (DMHC) Independent Medical Review (IMR) provides binding external