Topic

Insurance Approval

A collection of 2860 issues

How to Get Kesimpta (Ofatumumab) Covered by Cigna in Michigan: Forms, Appeals, and Approval Scripts

Answer Box: Getting Kesimpta Covered by Cigna in Michigan Kesimpta (ofatumumab) is on Cigna's formulary but requires prior authorization and may need step therapy. To get approved: 1) Have your neurologist submit a PA request with MS diagnosis, prior therapy failures, and clinical notes to Cigna/Express Scripts,

How Long Does It Take to Get Lutathera Approved by Cigna in California? Complete Timeline & Appeal Guide

Answer Box: Lutathera Approval Timeline in California Getting Lutathera (lutetium Lu-177 dotatate) approved by Cigna in California typically takes 3-7 days for standard prior authorization, or 24 hours for expedited requests when your doctor documents urgent medical need. California law requires Cigna to respond within 72 hours for standard requests

UnitedHealthcare's Coverage Criteria for Evkeeza in Texas: What Counts as "Medically Necessary"?

Answer Box: Getting Evkeeza Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Evkeeza (evinacumab-dgnb) with strict medical necessity criteria. You'll need documented homozygous familial hypercholesterolemia (HoFH), genetic testing or LDL-C ≥300 mg/dL on maximally tolerated therapy, and evidence of failed standard treatments. First step: Have

Blue Cross Blue Shield North Carolina Coverage Criteria for Jakafi (Ruxolitinib): Complete Prior Authorization Guide

Answer Box: Getting Jakafi Covered by Blue Cross Blue Shield NC Jakafi (ruxolitinib) requires prior authorization from Blue Cross Blue Shield of North Carolina and must be filled at an in-network specialty pharmacy. To get approved: 1. Submit comprehensive PA request with diagnosis documentation (myelofibrosis, polycythemia vera, or GVHD), prior

How to Get Cabometyx (Cabozantinib) Covered by Aetna CVS Health in Virginia: PA Requirements, Appeal Process & Forms

Answer Box: Getting Cabometyx Covered by Aetna CVS Health in Virginia Key Challenge: Cabometyx (cabozantinib) is excluded from Aetna's 2024 Advanced Control formulary, meaning standard coverage is denied. However, Virginia patients can pursue a formulary exception through Aetna's medical necessity process. Fastest Path to Approval: 1.

Get Cresemba (Isavuconazole) Covered by Aetna CVS Health in Washington: Forms, Appeals & Support

Answer Box: Getting Cresemba Covered by Aetna CVS Health in Washington Yes, Aetna CVS Health covers Cresemba (isavuconazole) with prior authorization for invasive aspergillosis and mucormycosis. The fastest path: submit a complete PA request through CVS Caremark's electronic portal with diagnosis documentation, prior antifungal trials, and infectious disease

How to Get Qalsody (Tofersen) Covered by Blue Cross Blue Shield in Illinois: Complete Guide to Prior Authorization, Appeals, and Financial Assistance

Answer Box: Getting Qalsody Covered by Blue Cross Blue Shield in Illinois Qalsody (tofersen) requires prior authorization from Blue Cross Blue Shield of Illinois and is limited to patients with confirmed SOD1 gene mutation causing ALS. The fastest path to approval: (1) Confirm SOD1 mutation with genetic testing results, (2)

Getting Therakos CELLEX Photopheresis Covered by Blue Cross Blue Shield in New Jersey: Prior Authorization, Appeals & Cost Strategies

Answer Box: Quick Path to Coverage Therakos CELLEX photopheresis requires prior authorization from Blue Cross Blue Shield in New Jersey. Your fastest path: 1) Have your specialist submit a comprehensive PA request through Horizon BCBS's provider portal with diagnosis, failed prior treatments, and medical necessity documentation. 2) If

Getting Pyrukynd (Mitapivat) Covered by Aetna CVS Health in Virginia: Complete Guide to Prior Authorization and Appeals

Answer Box: Your Path to Pyrukynd Coverage Getting Pyrukynd (mitapivat) covered by Aetna CVS Health in Virginia requires prior authorization with strict genetic and clinical criteria. You'll need confirmed pyruvate kinase deficiency with at least two PKLR gene variants (one missense), hemoglobin ≤10 g/dL or significant transfusion

How to Get Imbruvica (ibrutinib) Covered by Aetna CVS Health in Texas: Prior Authorization, Appeals, and Step-by-Step Guide

Answer Box: Getting Imbruvica Covered by Aetna CVS Health in Texas Imbruvica (ibrutinib) requires prior authorization from Aetna CVS Health but typically doesn't require step therapy for CLL/SLL or Waldenström macroglobulinemia. Your fastest path to approval: 1) Have your oncologist submit a prior authorization with diagnosis confirmation