Topic

Insurance Approval

A collection of 2618 issues

Getting Evkeeza (Evinacumab-dgnb) Covered by Cigna in Michigan: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Fast Track to Evkeeza Coverage in Michigan To get Evkeeza (evinacumab-dgnb) covered by Cigna in Michigan: Your doctor must submit prior authorization with confirmed HoFH diagnosis (genetic testing or clinical criteria), documentation of failed therapies (statin, ezetimibe, PCSK9 inhibitor), and recent LDL-C levels. Submit through Cigna's

How to Get Photrexa (Riboflavin) Covered by Aetna CVS Health in Pennsylvania: Prior Authorization Guide

Quick Answer: Getting Photrexa Covered by Aetna CVS Health in Pennsylvania Aetna CVS Health requires prior authorization for Photrexa (riboflavin ophthalmic solution) used in FDA-approved corneal cross-linking for progressive keratoconus in Pennsylvania. Your fastest path to approval: (1) Gather documented progression evidence (serial topography showing Kmax increases, pachymetry showing thinning)

Work With Your Doctor to Get Procysbi Covered by Blue Cross Blue Shield in New Jersey: Complete Provider Collaboration Guide

Quick Answer: Your Path to Procysbi Coverage Getting Procysbi (cysteamine bitartrate DR) covered by Blue Cross Blue Shield in New Jersey requires close collaboration with your doctor. Most BCBS plans require prior authorization and often mandate step therapy with immediate-release cysteamine first. Your fastest path: (1) Schedule a focused appointment

How Long Does It Take to Get Oxlumo (Lumasiran) Approved by Cigna in New Jersey? Complete Timeline Guide

Answer Box: Getting Oxlumo (Lumasiran) Approved by Cigna in New Jersey Timeline: Cigna typically reviews Oxlumo (lumasiran) prior authorization requests within 1-3 business days through Express Scripts. First step: Have your nephrologist or urologist submit genetic confirmation of PH1 (AGXT gene mutations), baseline urinary oxalate levels, and clinical documentation. If

How to Get Isturisa (Osilodrostat) Covered by UnitedHealthcare in Washington: Requirements Checklist and Appeals Guide

Answer Box: Getting Isturisa Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Isturisa (osilodrostat) for adult Cushing's disease patients who aren't surgical candidates or had unsuccessful surgery. The fastest path to approval: 1) Confirm your diagnosis with elevated urinary free cortisol and endocrinologist consultation,

How to Get Chenodal (chenodiol) Covered by UnitedHealthcare in Florida: Prior Authorization Forms, Appeals, and Step-by-Step Guide

Answer Box: Getting Chenodal Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Chenodial (chenodiol) and places it on a non-preferred specialty tier. Coverage is limited to cerebrotendinous xanthomatosis (CTX) with genetic confirmation—not gallstone dissolution. First step: Have your specialist submit a PA request through the UnitedHealthcare Provider

How to Get Cerezyme (Imiglucerase) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Fastest Path to Approval Cerezyme (imiglucerase) requires prior authorization from Aetna CVS Health in North Carolina. To get approved, you'll need: (1) confirmed Type 1 Gaucher disease diagnosis with enzyme testing and genetic confirmation, (2) completed Aetna Cerezyme Precertification Request Form, and (3) prescription from a

Getting Vyndaqel/Vyndamax (Tafamidis) Covered by Cigna in Ohio: Coding, Appeals, and Documentation Guide

Answer Box: Fast Track to Coverage Getting Vyndaqel/Vyndamax covered by Cigna in Ohio requires: (1) Confirmed ATTR-CM diagnosis with PYP scan or biopsy, (2) NYHA Class I-III heart failure documentation, and (3) cardiology specialist prescription. First step today: Have your cardiologist submit Cigna's prior authorization form with

Getting Prolastin-C Covered by Blue Cross Blue Shield of Michigan: PA Requirements, Appeals, and State Protections (2024-2025)

Answer Box: How to Get Prolastin-C Covered by BCBS Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Prolastin-C (alpha1-proteinase inhibitor) for commercial members, with specific criteria including confirmed alpha-1 antitrypsin deficiency, nonsmoker status, and symptomatic emphysema. Medicare Plus Blue and BCN Advantage members don't need

How to Get Zolgensma (Onasemnogene Abeparvovec) Covered by Humana in North Carolina: Complete Prior Authorization Guide

Quick Answer: Humana requires prior authorization for Zolgensma (onasemnogene abeparvovec) in North Carolina with strict age (<2 years), genetic testing, and clinical documentation requirements. Submit through Humana's provider portal with complete SMN1 testing, anti-AAV9 titers, and specialist consultation. If denied, use North Carolina's Smart NC