Topic

Insurance Approval

A collection of 5381 issues

How to Get Mavenclad (Cladribine Tablets) Covered by Aetna CVS Health in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Mavenclad Covered by Aetna CVS Health in Florida Aetna CVS Health requires prior authorization for Mavenclad (cladribine tablets) with documented failure of ≥2 prior disease-modifying therapies, lymphocyte count ≥800 cells/μL, and neurologist prescribing. Submit PA via Availity portal or fax 1-866-249-6155. Standard decisions take 72 hours;

Myths vs. Facts: Getting Poteligeo (mogamulizumab-kpkc) Covered by Cigna in New Jersey

Answer Box: Getting Poteligeo (mogamulizumab-kpkc) Covered by Cigna in New Jersey Cigna requires prior authorization for Poteligeo (mogamulizumab-kpkc) for relapsed/refractory mycosis fungoides or Sézary syndrome after ≥1 prior systemic therapy failure. Submit through Express Scripts/Accredo with complete TNMB staging, prior therapy documentation, and specialist oversight. If denied, file

Getting Eloctate Covered by Humana in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Eloctate (efmoroctocog alfa) requires prior authorization from Humana in Washington. Start by having your hematologist submit a complete PA form with bleeding history, prior therapy failures, and weight-based dosing calculations through Humana's provider portal. If denied, you have 65 days to appeal internally, then can request

How to Get Eylea or Lucentis Covered by Cigna in Illinois: Appeals Guide with Forms and Timelines

Quick Answer: Getting Eylea or Lucentis Approved by Cigna in Illinois Cigna requires prior authorization for Eylea (aflibercept) and Lucentis (ranibizumab) with step therapy requiring bevacizumab trial first. Submit PA requests through CoverMyMeds or call 1-800-882-4462. If denied, you have 180 days to appeal internally, then 4 months for Illinois

How to Get Tavalisse (fostamatinib) Covered by Aetna CVS Health in New Jersey: Complete Appeals Guide

Answer Box: Fast Track to Tavalisse Coverage Aetna CVS Health requires prior authorization for Tavalisse (fostamatinib) in New Jersey, with initial approval typically granted for 12 weeks when medical necessity criteria are met. The fastest path: have your hematologist submit a complete PA request through Availity with documented failure of

How to Get Xospata (Gilteritinib) Covered by Cigna in North Carolina: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Xospata (Gilteritinib) Covered by Cigna in North Carolina Xospata requires prior authorization from Cigna for relapsed/refractory AML with confirmed FLT3 mutation. Your fastest path: 1) Verify FLT3 test results (ITD or TKD via FDA-approved assay), 2) Have your hematologist/oncologist submit PA via Cigna portal with

How to Get Taltz (Ixekizumab) Covered by Aetna CVS Health in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Taltz Covered by Aetna CVS Health in New York Aetna CVS Health requires prior authorization for Taltz (ixekizumab) with step therapy requirements, TB screening, and specialist prescription. The fastest path: (1) Complete the Taltz precertification form with documented moderate-to-severe psoriasis (BSA >3% or PASI score), prior

Get Turalio (Pexidartinib) Covered by Aetna CVS Health in Virginia: Decision Tree, Forms & Appeals Guide

Answer Box: Quick Eligibility Check To get Turalio (pexidartinib) covered by Aetna CVS Health in Virginia, you need: confirmed TGCT diagnosis with imaging, surgical consultation stating "severe morbidity" if resected, REMS program enrollment, and baseline liver function tests. Submit complete prior authorization through CVS Specialty (1-800-237-2767) with all

How to Get Vitrakvi (Larotrectinib) Covered by Aetna CVS Health in Washington: PA Forms, Appeals, and Cost-Saving Strategies

Answer Box: Getting Vitrakvi Covered by Aetna CVS Health in Washington Aetna CVS Health requires prior authorization for Vitrakvi (larotrectinib) with NTRK gene fusion testing documentation. Submit PA via CVS Specialty at 1-888-267-3277 with molecular pathology report showing NTRK1/2/3 fusion, oncologist prescription, and staging records. If denied, Washington

How to Get Firdapse (amifampridine) Covered by Cigna in Pennsylvania: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Firdapse Covered by Cigna in Pennsylvania Yes, Cigna covers Firdapse (amifampridine) with prior authorization for confirmed Lambert-Eaton Myasthenic Syndrome (LEMS) in patients ≥6 years old. Your neurologist must submit a PA request through CoverMyMeds or Cigna's provider portal with EMG results showing ≥60% CMAP increment