Topic

Insurance Approval

A collection of 3045 issues

How to Get Oxlumo (Lumasiran) Covered by Cigna in Michigan: Complete Prior Authorization and Appeals Guide

Quick Answer: To get Oxlumo (lumasiran) covered by Cigna in Michigan, you'll need prior authorization with confirmed PH1 diagnosis, genetic testing (AGXT), nephrologist prescription, and documented urinary oxalate levels. Submit via CoverMyMeds or Cigna portal. If denied, use Michigan's 180-day internal appeal window, then DIFS external

Work With Your Doctor to Get Revcovi (Elapegademase) Covered by Humana in Ohio: Complete Provider Collaboration Guide

Answer Box: Getting Revcovi Approved Through Provider Partnership Fastest path to Humana approval for Revcovi (elapegademase) in Ohio: Work directly with your immunologist or pediatric hematologist/oncologist to submit a comprehensive prior authorization request that includes confirmed ADA-SCID diagnosis (genetic testing + enzyme activity <1% normal), documentation that curative therapies

Cigna's Coverage Criteria for Qinlock (Ripretinib) in New York: What Counts as "Medically Necessary"?

Quick Answer: Getting Qinlock (Ripretinib) Covered by Cigna in New York Cigna requires prior authorization for Qinlock (ripretinib) and enforces strict step therapy: you must have tried and failed imatinib, sunitinib, and regorafenib first. Medical necessity requires documented GIST diagnosis, progression after these three therapies, and oncologist prescription. First step

How to Get Prolastin-C Covered by Humana Medicare in Washington: Complete Guide with Forms and Appeal Scripts

Answer Box: Quick Path to Prolastin-C Coverage Getting Prolastin-C covered by Humana Medicare in Washington requires prior authorization and may involve step therapy. Here's your fastest path: 1. Confirm eligibility: Pi*ZZ genotype, FEV1 documentation, and emphysema diagnosis 2. Submit complete PA: Include AAT levels <11 µM,

How to Get Waylivra (Volanesorsen) Covered by Blue Cross Blue Shield Texas: Prior Authorization Guide, Appeals Process, and State Protections

Answer Box: Getting Waylivra Covered in Texas Waylivra (volanesorsen) requires formulary exception and prior authorization from Blue Cross Blue Shield of Texas since it's not FDA-approved in the US. For familial chylomicronemia syndrome (FCS), you'll need confirmed diagnosis, documented failure of standard triglyceride therapies, and specialist

Getting Kanuma (Sebelipase Alfa) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Cost-Saving Guide

Answer Box: Getting Kanuma Covered in Pennsylvania Kanuma (sebelipase alfa) is typically covered by Blue Cross Blue Shield plans in Pennsylvania as a specialty drug requiring prior authorization. To get coverage: 1. Submit PA request with LAL-D diagnosis confirmation (enzyme activity test + LIPA genetic testing) 2. Use specialty pharmacy (required

Get Alprolix Covered by Humana in Texas: Prior Authorization Guide with Appeal Templates

Quick Answer: Getting Alprolix Covered by Humana in Texas Alprolix requires prior authorization from Humana and typically faces step therapy requirements. Your fastest path: 1) Have your hematologist submit a PA request with bleeding history and failed preferred alternatives, 2) Route prescriptions through CenterWell Specialty Pharmacy, 3) If denied, you

Work With Your Doctor to Get HyperHEP (Hepatitis B Immune Globulin) Approved by Blue Cross Blue Shield in Pennsylvania

Answer Box: Getting HyperHEP Covered by Blue Cross Blue Shield in Pennsylvania Blue Cross Blue Shield Pennsylvania (Highmark and Independence) requires prior authorization for HyperHEP (hepatitis B immune globulin). Your fastest path to approval: work with your doctor to submit a complete prior authorization request documenting post-exposure prophylaxis need within

Getting Orkambi (lumacaftor/ivacaftor) Covered by Cigna in North Carolina: Complete Guide to Prior Authorization, Appeals, and Templates

Quick Answer: Getting Orkambi Covered by Cigna in North Carolina Cigna requires prior authorization for Orkambi (lumacaftor/ivacaftor) with proof of homozygous F508del mutation and CF specialist prescription. If denied, you have 180 days for internal appeals, then can request external review through North Carolina's Smart NC program.

Renewing Ruconest (C1 Esterase Inhibitor) Approval with Humana in Texas: Complete Guide to Documentation and Timelines

Answer Box: Renewing Ruconest with Humana in Texas Start your renewal 30 days before expiration. Humana requires updated clinical documentation showing ongoing medical necessity for hereditary angioedema (HAE), including attack frequency reduction and treatment response. Submit via Humana's provider portal with prescriber attestation, recent clinical notes, and evidence