Topic

Insurance Approval

A collection of 2797 issues

How to Get Orkambi (lumacaftor/ivacaftor) Covered by Aetna (CVS Health) in North Carolina: Complete Approval Guide

Answer Box: Get Orkambi Covered by Aetna in North Carolina Fastest Path to Approval: Aetna requires prior authorization for Orkambi with genetic testing confirming F508del homozygosity, pulmonologist prescription, and documentation of cystic fibrosis diagnosis. Submit through CVS Caremark specialty pharmacy with complete documentation. If denied, use North Carolina's

How to Get Enbrel (Etanercept) Covered by Blue Cross Blue Shield in Ohio: Complete Requirements Guide

Answer Box: Getting Enbrel Covered by Blue Cross Blue Shield in Ohio Blue Cross Blue Shield in Ohio requires prior authorization for Enbrel (etanercept), typically mandating step therapy with biosimilar alternatives first. To get approval: 1) Complete the PA form with detailed clinical documentation showing failed trials of conventional DMARDs

How to Get Procysbi (Cysteamine Bitartrate DR) Covered by Cigna in Virginia: Timeline, Appeals, and Step Therapy Guide

Answer Box: Getting Procysbi Covered by Cigna in Virginia Procysbi (cysteamine bitartrate DR) requires prior authorization from Cigna in Virginia, with standard review completed within one business day. Your fastest path: (1) Have your nephrologist or metabolic specialist gather diagnostic confirmation (genetic testing or elevated WBC cystine levels), (2) document

Work With Your Doctor to Get Sumavel DosePro Covered by Humana in New York: Complete Prior Authorization Guide

Answer Box: Getting Sumavel DosePro Covered by Humana in New York Note: Sumavel DosePro has been discontinued in the U.S. However, if you have a prescription or need coverage for similar needle-free sumatriptan delivery systems, Humana Medicare Advantage requires step therapy with oral triptans first. You'll need

Myths vs. Facts: Getting Enbrel (Etanercept) Covered by Blue Cross Blue Shield in North Carolina

Answer Box: Getting Enbrel Covered by Blue Cross Blue Shield in North Carolina Eligibility: Blue Cross Blue Shield of North Carolina covers Enbrel (etanercept) with prior authorization for FDA-approved conditions like rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Step therapy required - you must try biosimilar alternatives first unless contraindicated.

How to Get Hemlibra (Emicizumab) Covered by UnitedHealthcare in California: Complete Guide to Forms, Appeals, and Approval

Quick Answer: Getting Hemlibra Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Hemlibra (emicizumab-kxwh) in California. The fastest path: Your doctor submits a PA request through the UnitedHealthcare Provider Portal with clinical documentation showing hemophilia A diagnosis and inhibitor status. If denied, file an internal appeal within 180

Myths vs. Facts: Getting Firazyr (Icatibant) Covered by Cigna in Florida - Appeals Guide

Quick Answer: Getting Firazyr (Icatibant) Covered by Cigna in Florida Yes, Cigna covers Firazyr (icatibant) for acute HAE attacks in Florida, but requires prior authorization with specific documentation. The fastest path: 1) Confirm your HAE diagnosis with lab results (low C4, low functional C1-INH), 2) Have an allergist/immunologist submit

How to Get Carbaglu (Carglumic Acid) Covered by Humana in Virginia: Complete Appeals Guide

Answer Box: Getting Carbaglu Covered by Humana in Virginia Humana requires prior authorization for Carbaglu (carglumic acid) for NAGS deficiency treatment. In Virginia, you have strong appeal rights through the State Corporation Commission Bureau of Insurance. First steps: 1) Gather genetic confirmation of NAGS deficiency and elevated ammonia labs, 2)

How to Get Joenja (leniolisib) Covered by Aetna (CVS Health) in North Carolina: Complete Guide to Prior Authorization, Appeals, and Cost Assistance

Answer Box: Getting Joenja (leniolisib) Covered by Aetna (CVS Health) in North Carolina Joenja (leniolisib) requires prior authorization from Aetna (CVS Health) with genetic confirmation of APDS, specialist prescriber, and patient meeting age/weight criteria (≥12 years, ≥45 kg). The medication costs $250 per 30-day supply on the specialty tier,

How to Get Uplizna (inebilizumab) Covered by Cigna in Michigan: Medical Necessity Criteria & Appeal Process

Answer Box: Getting Uplizna (inebilizumab) Covered by Cigna in Michigan Cigna requires prior authorization for Uplizna (inebilizumab) with specific medical necessity criteria: You must be 18+ with AQP4-positive NMOSD or IgG4-related disease, prescribed by/with a neurologist, and have completed HBV screening. Fastest path: Complete Cigna's prior authorization