Topic

Insurance Approval

A collection of 2806 issues

Getting Kesimpta (Ofatumumab) Covered by Blue Cross Blue Shield of North Carolina: Complete Prior Authorization and Appeal Guide

Quick Answer: Kesimpta requires prior authorization from Blue Cross Blue Shield of North Carolina and is typically placed in Tier 5 (specialty). Your doctor must document relapsing MS diagnosis, prior treatment failures, and complete HBV screening. If denied, you can appeal internally, then through North Carolina's Smart NC

How to Get Signifor LAR (Pasireotide) Covered by Aetna in Michigan: Prior Authorization Forms and Appeal Guide

Answer Box: Getting Signifor LAR Covered by Aetna in Michigan Aetna requires prior authorization for Signifor LAR (pasireotide) in Michigan. You must document trial and failure of Somatuline Depot (lanreotide) first, plus provide biochemical evidence (elevated UFC for Cushing's disease or IGF-1 for acromegaly). Submit via CVS Specialty

How to Get Rystiggo (Rozanolixizumab-noli) Covered by Blue Cross Blue Shield in Georgia: Forms, Appeals, and Success Strategies

Quick Answer: Getting Rystiggo Covered in Georgia Yes, Blue Cross Blue Shield Georgia covers Rystiggo (rozanolixizumab-noli) for generalized myasthenia gravis, but prior authorization is required. Your fastest path to approval: 1) Confirm your antibody status (AChR+ or MuSK+) with your neurologist, 2) Document failed standard therapies, and 3) Submit the

How to Get Photrexa (Riboflavin) Covered by Blue Cross Blue Shield in Ohio: Complete PA Guide and Appeal Timeline

Answer Box: Getting Photrexa Covered by Blue Cross Blue Shield in Ohio Blue Cross Blue Shield in Ohio covers Photrexa (riboflavin) for corneal cross-linking when you have documented progressive keratoconus and meet specific prior authorization requirements. The fastest path: 1) Gather corneal topography showing Kmax progression ≥1.0 diopter over

Work With Your Doctor to Get Eylea and Lucentis Covered by Cigna in North Carolina: Complete Appeals Guide

Answer Box: Getting Eylea/Lucentis Covered by Cigna in North Carolina Eligibility: Cigna covers Eylea (aflibercept) and Lucentis (ranibizumab) for wet AMD, diabetic macular edema, and other retinal conditions, but requires prior authorization and typically step therapy with bevacizumab first. Fastest Path: Your ophthalmologist submits a prior authorization through Cigna&

How to Get Mycapssa (Octreotide Oral) Covered by Humana in Washington: Complete Prior Authorization Guide

Answer Box: Getting Mycapssa Covered by Humana in Washington Mycapssa (oral octreotide) requires prior authorization from Humana and typically needs documentation of prior response to injectable octreotide or lanreotide for acromegaly. Here's the fastest path: 1. Gather documentation: Confirmed acromegaly diagnosis (elevated IGF-1), prior injectable SSA therapy records,

How to Get Poteligeo (mogamulizumab-kpkc) Covered by Humana in New Jersey: Complete Guide with Forms and Appeals

Quick Answer: Getting Poteligeo Covered by Humana in New Jersey Poteligeo (mogamulizumab-kpkc) requires prior authorization from Humana for cutaneous T-cell lymphoma treatment. Submit documentation through CenterWell Specialty Pharmacy showing relapsed/refractory mycosis fungoides or Sézary syndrome with prior systemic therapy failures. If denied, New Jersey's IHCAP external review

Getting Soliris (Eculizumab) Covered by Humana in Washington: Complete Prior Authorization and Appeals Guide

Quick Start: Getting Soliris Covered by Humana in Washington Soliris (eculizumab) requires prior authorization from Humana in Washington and is covered under the medical benefit (Part B/Medicare Advantage), not pharmacy benefit. The fastest path to approval: (1) Ensure meningococcal vaccination is current and documented, (2) Have your provider submit

How to Get Voydeya (Danicopan) Covered by Cigna in Washington: Prior Authorization, Appeals & Approval Timeline

Answer Box: Getting Voydeya (Danicopan) Covered by Cigna in Washington Voydeya (danicopan) is on Cigna's formulary but requires prior authorization for patients with paroxysmal nocturnal hemoglobinuria (PNH). To get approved in Washington: 1. Ensure you meet criteria: Must have PNH confirmed by flow cytometry and documented extravascular hemolysis

Get Elevidys Covered by UnitedHealthcare in California: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Elevidys Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Elevidys (delandistrogene moxeparvovec-rokl) gene therapy for DMD. The fastest path to approval involves three key steps: (1) Submit a complete PA request through the UnitedHealthcare Provider Portal with genetic confirmation, anti-AAVrh74 antibody results ≤1:400, and