Topic

Insurance Approval

A collection of 2699 issues

How to Get Keytruda (Pembrolizumab) Covered by Blue Cross Blue Shield in Ohio: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Keytruda Covered in Ohio Keytruda (pembrolizumab) requires prior authorization from Blue Cross Blue Shield in Ohio. The fastest path to approval involves three steps: 1) Gather biomarker test results (PD-L1, MSI-H, or TMB-H as required by your cancer type), 2) Submit complete prior authorization through your provider&

How to Get Thiola / Thiola EC (Tiopronin) Covered by Humana in New York: Appeals, Timelines, and State Protections

Answer Box: Fast Track to Thiola Coverage Getting Thiola/Thiola EC approved by Humana in New York requires three key steps: First, ensure your prescriber documents failed conservative treatments (hydration, alkalinization) and includes a 24-hour urine cystine level showing elevated excretion. Second, if denied, file an internal appeal within 65

Complete Guide: Getting Busulfex (Busulfan Injection) Covered by Aetna in New York - Prior Authorization, Appeals & Forms

Answer Box: Getting Busulfex Covered by Aetna in New York Busulfex (busulfan injection) requires prior authorization from Aetna for transplant conditioning in chronic myeloid leukemia. The fastest path to approval involves three key steps: (1) Confirm your transplant center is an Aetna Institute of Excellence facility, (2) Have your transplant

How to Get Strensiq (Asfotase Alfa) Covered by Cigna in North Carolina: Complete PA Guide and Appeals Strategy

Answer Box: Getting Strensiq Covered by Cigna in North Carolina Strensiq (asfotase alfa) requires prior authorization from Cigna and is typically covered only for pediatric-onset hypophosphatasia with strict documentation requirements. Your fastest path to approval: (1) Work with an HPP specialist to gather genetic testing, low ALP levels, and clinical

If Pemazyre (Pemigatinib) Isn't Approved by Aetna CVS Health in Ohio: Formulary Alternatives & Exception Paths

Answer Box: Fast Track to Pemazyre Coverage If Aetna CVS Health denies Pemazyre (pemigatinib) in Ohio, you have three main paths: formulary exception request (if non-formulary), prior authorization appeal (if denied for medical necessity), or trying alternative FGFR inhibitors first. Most denials stem from missing FGFR2 fusion test results or

How to Get Enbrel (etanercept) Covered by Cigna in Michigan: Complete Prior Authorization Guide

Answer Box: Getting Enbrel Covered by Cigna in Michigan Eligibility: Cigna covers Enbrel (etanercept) for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis with prior authorization. You must be over 18, prescribed by a rheumatologist, and have tried another biologic (excluding etanercept biosimilars). Fastest path: Your doctor submits a

Renewing Givlaari (givosiran) Approval with Cigna in Illinois: Complete Guide to Documentation, Timelines, and Appeals

Quick Answer: Givlaari (givosiran) renewal with Cigna requires annual documentation showing reduced attack frequency, ongoing specialist care, and absence of serious toxicity. Submit renewal requests 2-4 weeks before your current approval expires. If denied, you have 180 days for internal appeals and 30 days for Illinois external review. Start gathering

How to Get Tepezza (Teprotumumab) Covered by Aetna CVS Health in Washington: Prior Authorization Forms, Appeal Process & Success Strategies

Answer Box: Getting Tepezza Covered by Aetna CVS Health in Washington Fastest path to approval: Your ophthalmologist submits Aetna's Tepezza Precertification Form with documented moderate-to-severe TED diagnosis and evidence of failed step therapy (prednisone, methimazole). If denied, file internal appeals within 180 days, then request external review through

Getting Vitrakvi (Larotrectinib) Covered by Cigna in New Jersey: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Vitrakvi (Larotrectinib) Covered by Cigna in New Jersey Eligibility: Cigna requires prior authorization for Vitrakvi (larotrectinib) with documented NTRK gene fusion, unresectable/metastatic solid tumors, and oncologist prescribing. Fastest path: Submit PA request via CoverMyMeds portal with NTRK fusion test results, prior therapy documentation, and medical necessity

How to Get Alprolix Covered by Aetna CVS Health in New York: Formulary Status, Appeals Process & PA Requirements

Quick Answer: Getting Alprolix Covered by Aetna CVS Health in New York Challenge: Alprolix is excluded from Aetna's 2024 Advanced Control Formulary, meaning routine prior authorization isn't available. Path forward: Request a coverage exception with strong medical necessity documentation from your hematologist. First step today: Contact