Topic

Insurance Approval

A collection of 6342 issues

Cigna's Coverage Criteria for Pombiliti (cipaglucosidase alfa-atga) in Michigan: What Counts as "Medically Necessary"?

Answer Box: Getting Pombiliti Covered by Cigna in Michigan Cigna requires prior authorization for Pombiliti + Opfolda combination therapy for late-onset Pompe disease patients ≥18 years, weighing >40 kg, who show no improvement in forced vital capacity (FVC) or 6-minute walk test after ≥1 year on Lumizyme or Nexviazyme. Submit

How to Get Eloctate Approved by Cigna in Florida: Timeline, Forms & Appeal Success Strategies

Quick Answer: Getting Eloctate Approved by Cigna in Florida Eloctate (efmoroctocog alfa) requires prior authorization from Cigna in Florida, typically processed within 72 hours for standard requests or 24 hours for urgent cases. Your doctor submits via CoverMyMeds or calls 1-800-882-4462. Key requirements: hemophilia A diagnosis (ICD-10: D66), prescription by

How Long Does It Take to Get Opfolda (miglustat) Approved by UnitedHealthcare in Texas? Complete Timeline Guide

Answer Box: Opfolda Approval Timeline in Texas Getting Opfolda (miglustat) approved by UnitedHealthcare in Texas typically takes 7-14 business days for standard review, with expedited approval possible in 24-72 hours for urgent cases. The drug requires prior authorization and must be prescribed with Pombiliti for late-onset Pompe disease in adults

Getting Cosentyx (Secukinumab) Covered by Humana in Texas: Prior Authorization Forms, Appeals, and Success Strategies

Answer Box: Your Fastest Path to Cosentyx Coverage Cosentyx (secukinumab) requires prior authorization for all Humana plans in Texas. Submit the Texas Standardized Prior Authorization Request Form via fax (1-888-447-3430) or Humana's provider portal. Include your diagnosis with ICD-10 code, prior therapy failures, PASI/BSA scores, and specialist

How Long Does It Take to Get Amvuttra (vutrisiran) Approved by Cigna in California? Complete Timeline Guide

Answer Box: Fastest Path to Amvuttra (vutrisiran) Approval Getting Amvuttra (vutrisiran) covered by Cigna in California typically takes 72 hours for complete submissions, or 24 hours for urgent cases. You'll need genetic testing confirming a TTR pathogenic variant, documented polyneuropathy (hATTR-PN) or cardiomyopathy (ATTR-CM), and may face step

Do You Qualify for Krystexxa Coverage by Blue Cross Blue Shield in Pennsylvania? Decision Tree & Next Steps

Answer Box: Quick Qualification Check Getting Krystexxa (pegloticase) covered by Blue Cross Blue Shield in Pennsylvania requires: (1) chronic gout refractory to allopurinol/febuxostat at maximum doses for ≥3 months with serum uric acid >6 mg/dL, (2) ≥2 flares in past 12 months or tophi present, and (3)

How to Get Ofev (nintedanib) Covered by Cigna in Michigan: ICD-10 Codes, Prior Authorization, and Appeal Scripts

Answer Box To get Ofev (nintedanib) covered by Cigna in Michigan: Your pulmonologist must submit prior authorization using Michigan's standardized PA form (FIS 2288) with ICD-10 code J84.112 (IPF) or M34.81 (SSc-ILD), HRCT confirming fibrosis, and PFTs showing FVC ≥40% predicted. Cigna has 15 days to

Getting Qalsody (Tofersen) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Qalsody (Tofersen) Covered by UnitedHealthcare in New Jersey UnitedHealthcare covers Qalsody (tofersen) for adults with ALS and confirmed SOD1 mutations, requiring prior authorization through OptumRx. In New Jersey, if denied, you can appeal through UnitedHealthcare's internal process, then file for external review with New Jersey&

How to Get Cimzia (Certolizumab Pegol) Covered by Cigna in Washington: Complete PA Guide and Appeal Process

Answer Box: Getting Cimzia Covered by Cigna in Washington Cigna requires prior authorization for Cimzia (certolizumab pegol) across all FDA-approved conditions. In Washington, your fastest path to approval involves: (1) Having your specialist submit the PA form with documented failure of conventional therapy and preferred TNF inhibitors, plus required TB/

Lowering Out-of-Pocket for Elzonris (Tagraxofusp-erzs) with Cigna in Ohio: Complete Copay, Tiering & Financial Assistance Guide

Answer Box: Getting Elzonris Covered by Cigna in Ohio Elzonris (tagraxofusp-erzs) requires prior authorization from Cigna and is placed in Tier 4 (specialty tier) with high out-of-pocket costs. To minimize expenses: (1) Apply for Stemline's copay card (up to $25,000/year coverage) and patient assistance program (free