Topic

Insurance Approval

A collection of 2746 issues

Get Firdapse (Amifampridine) Covered by UnitedHealthcare in Illinois: Complete Requirements Checklist

Answer Box: Getting Firdapse Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Firdapse (amifampridine) to treat Lambert-Eaton myasthenic syndrome (LEMS). The fastest path to approval: (1) Confirm your neurologist has documented LEMS diagnosis with antibody testing and EMG findings, (2) Submit the UnitedHealthcare prior authorization form with clinical

How to Get Gilenya (Fingolimod) Covered by Aetna CVS Health in Washington: 2025 Prior Authorization Guide

Answer Box: Quick Path to Coverage Aetna CVS Health requires prior authorization for Gilenya (fingolimod) in Washington, with mandatory step therapy through generic fingolimod first. Your neurologist must document relapsing MS diagnosis, submit baseline EKG and monitoring plan, and provide evidence of generic failure/intolerance for brand approval. If denied,

Denied for Jynarque (Tolvaptan) by Humana in Virginia? Complete Appeal Guide with Forms & Templates

Quick Answer: To get Jynarque (tolvaptan) covered by Humana in Virginia, you'll need prior authorization showing rapid ADPKD progression (Mayo Class 1C-1E or eGFR decline ≥3.0 ml/min/1.73m²/year), REMS enrollment, and baseline liver function tests. If denied, you have 65 days to appeal to

Renewing Krystexxa (Pegloticase) Coverage with Cigna in North Carolina: Complete Guide for 2025

Answer Box: Renewing Krystexxa Coverage with Cigna in North Carolina Cigna requires prior authorization renewal for Krystexxa (pegloticase) every 12 months with strict documentation of ongoing response. Start your renewal 2-4 weeks before expiration to avoid treatment gaps. Essential requirements: serum uric acid levels below 6 mg/dL before infusions,

Do You Qualify for Kanuma (Sebelipase Alfa) Coverage by UnitedHealthcare in New Jersey? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Kanuma Coverage in New Jersey Yes, you can get Kanuma (sebelipase alfa) covered by UnitedHealthcare in New Jersey if you have confirmed LAL-D diagnosis. UnitedHealthcare requires prior authorization through OptumRx with specific clinical documentation. First step today: Gather your LAL enzyme test results and

How to Get Elelyso (Taliglucerase Alfa) Covered by Cigna in Pennsylvania: Appeals, Timelines & Step Therapy Override

Quick Answer: Getting Elelyso Covered by Cigna in Pennsylvania Elelyso (taliglucerase alfa) requires prior authorization from Cigna before coverage. In Pennsylvania, you have strong appeal rights if denied, including step therapy override protections and a new state external review program with 50% overturn rates. First step today: Have your doctor

Lowering Out-of-Pocket Costs for Zokinvy (lonafarnib) with Blue Cross Blue Shield in Washington: Copay Cards, Tiering Exceptions & Financial Assistance

Answer Box: Getting Zokinvy Covered at Lower Cost For Washington residents with Blue Cross Blue Shield: Zokinvy (lonafarnib) is typically placed on specialty tiers with high cost-sharing. To reduce out-of-pocket costs: 1) Apply for the Sentynl Cares copay assistance program if you have commercial insurance, 2) Request a formulary tier

How Long Does It Take to Get Hemgenix (etranacogene dezaparvovec) Approved by Humana in New Jersey? Complete Timeline Guide

Answer Box: What You Need to Know Getting Hemgenix (etranacogene dezaparvovec) approved by Humana in New Jersey typically takes 7-30 days for standard review, or 72 hours for expedited cases. The fastest path requires complete documentation upfront: Factor IX levels ≤2%, bleeding history, genetic confirmation, and liver function tests. Start

How to Get Fintepla (fenfluramine) Covered by Humana in New York: Complete Guide with Forms and Appeals

Answer Box: Getting Fintepla Covered by Humana in New York Fintepla (fenfluramine) requires prior authorization from Humana for Dravet syndrome and Lennox-Gastaut syndrome patients. The fastest path to approval involves three critical steps: 1) Complete REMS enrollment for both prescriber and patient, 2) Submit baseline echocardiogram showing cardiac safety, and

The Requirements Checklist to Get Retevmo (selpercatinib) Covered by UnitedHealthcare in Pennsylvania

Answer Box: Fast Track to Approval To get Retevmo (selpercatinib) covered by UnitedHealthcare in Pennsylvania: 1) Confirm RET fusion-positive status with FDA-approved testing (FoundationOne CDx preferred), 2) Submit prior authorization through UnitedHealthcare provider portal with complete molecular pathology reports and clinical documentation, 3) If denied, file internal appeal within 6