Topic

Insurance Approval

A collection of 2825 issues

How to Get Epidiolex (Cannabidiol) Covered by Blue Cross Blue Shield in New York: Complete Decision Tree & Appeal Guide

Answer Box: Your Path to Epidiolex Coverage Epidiolex requires prior authorization from Blue Cross Blue Shield New York plans in 2024. You'll likely qualify if you have a confirmed diagnosis of Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex, plus documented failure of standard anti-seizure medications. First step

Getting Dojolvi (Triheptanoin) Covered by Aetna CVS Health in New York: Complete Guide to Approval, Appeals & Forms

Answer Box: Quick Path to Coverage Dojolvi (triheptanoin) is not on Aetna's 2024 formulary, requiring a formulary exception or prior authorization based on medical necessity. In New York, you have strong appeal rights through the state's external review system if initially denied. Fastest approval path: 1.

Get Advate (octocog alfa) Covered by Aetna CVS Health in Pennsylvania: Complete Guide with Forms and Appeal Process

Answer Box: Getting Advate Covered by Aetna CVS Health in Pennsylvania Yes, Advate (octocog alfa) is covered by Aetna CVS Health in Pennsylvania, but requires prior authorization. Aetna prefers Kovaltry for routine prophylaxis, so you'll need to document failure or intolerance to Kovaltry first. Your hematologist must submit

How to Get Evkeeza (evinacumab-dgnb) Approved by Cigna in Texas: Timeline, Forms & Appeal Process

Quick Answer: Getting Evkeeza Approved by Cigna in Texas Cigna requires prior authorization for Evkeeza (evinacumab-dgnb) to treat homozygous familial hypercholesterolemia (HoFH). Timeline: 7 days for standard review, 72 hours for urgent cases (effective 2026). First step: Gather HoFH diagnosis confirmation, prior therapy records, and recent LDL-C levels. Submit through

How to Get Thiola / Thiola EC (tiopronin) Covered by Aetna CVS Health in New York: Complete PA Guide

Answer Box: Quick Path to Thiola Coverage Getting Thiola/Thiola EC covered by Aetna CVS Health in New York requires prior authorization with step therapy documentation. Submit a complete PA request through the Availity portal including: confirmed cystinuria diagnosis (24-hour urine cystine ≥300 mg/day), documented failure of conservative therapy,

Denied for Adynovate by UnitedHealthcare in California? How to Appeal (Templates & Timelines)

Answer Box: Getting Adynovate Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Adynovate (bdanocog alfa pegol) with step therapy requirements. If denied, California residents can appeal through internal grievances, then request an Independent Medical Review (IMR) with high success rates for medically necessary treatments. First step today: Call

How to Get Xospata (Gilteritinib) Covered by Aetna CVS Health in California: Timeline, Appeals, and Approval Steps

Answer Box: Getting Xospata Covered by Aetna CVS Health in California Xospata (gilteritinib) requires prior authorization from Aetna CVS Health but is covered for relapsed/refractory AML with FLT3 mutations. Most approvals happen within 24 hours of complete submission. Key requirements: confirmed FLT3 mutation test, AML diagnosis, and prior therapy

How to Get Xembify (Immune Globulin, SC) Covered by Cigna in Washington: Complete Guide with Forms and Appeals

Answer Box: Getting Xembify Covered by Cigna in Washington Fastest path to approval: Your doctor submits prior authorization through CoverMyMeds or faxes Cigna's specialty drug PA form with clinical documentation showing primary immunodeficiency diagnosis, low immunoglobulin levels, and infection history. If denied, file internal appeals within 180 days,

Get Jakafi (Ruxolitinib) Covered by Cigna in New Jersey: PA Forms, Appeals & Cost Assistance

Answer Box: Fastest Path to Jakafi Coverage with Cigna in New Jersey Jakafi (ruxolitinib) requires prior authorization from Cigna and is typically covered for FDA-approved indications (myelofibrosis, polycythemia vera, GVHD) when clinical criteria are met. Your prescriber must submit a PA request through Cigna's provider portal with documentation

How to Get Lutathera (Lutetium Lu-177 Dotatate) Covered by Aetna CVS Health in North Carolina: Forms, Appeals, and Cost-Saving Strategies

Answer Box: Getting Lutathera Covered by Aetna CVS Health in North Carolina Aetna requires prior authorization for Lutathera (lutetium Lu-177 dotatate) with strict criteria for somatostatin receptor-positive GEP-NETs. Your fastest path: Have your oncologist submit complete documentation (diagnosis, SSTR+ imaging, prior therapy failures) via Aetna's provider portal. Standard