Topic

Insurance Approval

A collection of 2891 issues

How to Get Xywav (Ca/Mg/K/Na oxybates) Covered by Cigna in California: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Xywav Covered by Cigna in California Cigna requires prior authorization for Xywav with strict criteria: confirmed narcolepsy/idiopathic hypersomnia diagnosis, sleep studies, specialist prescription, failed dextroamphetamine trial, and REMS enrollment. First step: Have your sleep specialist submit PA request with complete documentation to Cigna/Express Scripts. If

The Requirements Checklist to Get Poteligeo (mogamulizumab-kpkc) Covered by UnitedHealthcare in Florida: Forms, Appeals, and Documentation Guide

Quick Answer: Getting Poteligeo Covered by UnitedHealthcare in Florida Poteligeo (mogamulizumab-kpkc) requires prior authorization through OptumRx for UnitedHealthcare members in Florida. Your fastest path to approval: (1) Confirm you have relapsed/refractory mycosis fungoides or Sézary syndrome after ≥1 prior systemic therapy, (2) Submit complete clinical documentation via the UnitedHealthcare

How to Get Poteligeo (mogamulizumab-kpkc) Covered by Humana in Illinois: Timeline, Appeals, and Approval Scripts

Answer Box: Getting Poteligeo (mogamulizumab-kpkc) Covered by Humana in Illinois Fastest path to approval: Submit prior authorization through your oncologist/dermatologist with documented relapsed/refractory mycosis fungoides or Sézary syndrome after ≥1 prior systemic therapy. Humana typically decides within 14 days (7 days starting 2026). First step today: Have your

How to Get Eloctate Covered by Blue Cross Blue Shield of Texas: Medical Necessity Criteria and Appeal Guide

Quick Answer: Blue Cross Blue Shield of Texas requires prior authorization for Eloctate (efmoroctocog alfa) and lists it as non-preferred, meaning you'll likely need to try preferred alternatives like Adynovate or Jivi first. To get coverage, your hematologist must document hemophilia A diagnosis, failed preferred therapies, and medical

How to Get Turalio (Pexidartinib) Covered by Humana in California: Prior Authorization Guide

Answer Box: Getting Turalio Covered by Humana in California Turalio (pexidartinib) requires prior authorization from Humana and is typically placed on Tier 5 (specialty tier). To get approved in California: 1. Complete REMS enrollment - Both prescriber and patient must enroll in the Turalio REMS Program 2. Submit comprehensive PA

Getting Orfadin (Nitisinone) Covered by Cigna in New York: Coding, Appeals & Prior Authorization Guide

Answer Box: Getting Orfadin (Nitisinone) Covered by Cigna in New York Orfadin (nitisinone) for hereditary tyrosinemia type 1 requires Cigna prior authorization using ICD-10 code E70.29 and HCPCS J8499. Key steps: 1) Confirm HT-1 diagnosis with elevated succinylacetone levels, 2) Submit PA with specialist documentation and dietary management plan,

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

Quick Answer: Getting Orkambi Covered by Aetna CVS Health in Florida Aetna CVS Health requires prior authorization for Orkambi (lumacaftor/ivacaftor) in Florida. Your fastest path to approval: (1) Confirm F508del homozygous mutation documentation, (2) Submit complete prior authorization via Availity provider portal with CF diagnosis and failed therapy history,

How to Get Darzalex Covered by Humana in New York: Step Therapy Laws, Appeals Process, and Prior Authorization Guide

Answer Box: Getting Darzalex Covered by Humana in New York Darzalex (daratumumab) requires prior authorization from Humana Medicare Advantage plans in New York. If denied, you can appeal internally and request external review through the New York Department of Financial Services (DFS) within four months. New York's step

How to Get Soliris (Eculizumab) Covered by Blue Cross Blue Shield in New Jersey: Complete Timeline & Appeal Guide

Answer Box: Getting Soliris Covered by BCBS in New Jersey Horizon Blue Cross Blue Shield of New Jersey requires prior authorization for Soliris (eculizumab) with approval typically taking 5-15 days for standard requests. Your fastest path: (1) Ensure meningococcal vaccination is current, (2) Have your doctor submit complete PA documentation

Getting Kuvan (Sapropterin) Covered by Humana in North Carolina: Complete Coding & Appeals Guide

Quick Answer: Your Path to Kuvan Coverage Kuvan (sapropterin) requires prior authorization from Humana, billed under Medicare Part D using NDC codes (not J-codes). Key steps: 1) Ensure correct ICD-10 coding (E70.0 for classical PKU, E70.1 for other hyperphenylalaninemia), 2) Submit weight-based dosing documentation with specialist confirmation, 3)