Topic

Insurance Approval

A collection of 2902 issues

How to Get Translarna (Ataluren) Covered by Aetna CVS Health in Michigan: Complete Requirements Guide

Quick Answer: Getting Translarna Covered by Aetna CVS Health in Michigan Translarna (ataluren) requires prior authorization from Aetna CVS Health in Michigan. The fastest path to approval: (1) Submit PA request through Availity portal with genetic testing confirming nonsense mutation DMD, (2) Include ambulatory status documentation and medical necessity letter,

How to Get Alecensa (alectinib) Approved by Blue Cross Blue Shield Illinois: Complete Prior Authorization Guide

Quick Answer: Getting Alecensa Covered by BCBS Illinois Alecensa (alectinib) requires prior authorization from Blue Cross Blue Shield of Illinois for ALK-positive NSCLC. Your fastest path to approval: (1) Confirm ALK-positive test results are documented, (2) Submit PA request through Availity Essentials or provider portal with complete clinical documentation, (3)

How to Get Orkambi (lumacaftor/ivacaftor) Covered by Cigna in California: Appeals Timeline and Documentation Guide

Answer Box: Getting Orkambi Covered by Cigna in California Fastest Path: Submit prior authorization with genetic test results showing F508del homozygosity, CF diagnosis documentation, and specialist prescription. If denied, file internal appeal within 180 days, then request California Independent Medical Review (IMR) through DMHC. Success rate for IMR appeals is

Get Jynarque (Tolvaptan) Covered by Humana in Michigan: Appeal Templates & Timelines

Quick Answer: Getting Jynarque Covered by Humana in Michigan Eligibility: Adults (18+) with rapidly progressing ADPKD meeting Mayo classification 1C-1E or documented eGFR decline ≥3.0 ml/min/1.73m²/year. Fastest path: Have your nephrologist submit prior authorization with imaging, genetic testing, and REMS enrollment. First step today: Contact

How to Get Venclexta (Venetoclax) Covered by Humana in Florida: Complete Prior Authorization Guide

Answer Box: Getting Venclexta (Venetoclax) Covered by Humana in Florida Venclexta (venetoclax) requires prior authorization for all Humana Medicare Advantage plans in Florida. The fastest path to approval involves submitting a complete Medicare Part D coverage determination request with detailed clinical justification, tumor lysis syndrome (TLS) monitoring plan, and baseline

Blue Cross Blue Shield California Tecentriq Coverage: Medical Necessity Requirements and Appeal Process

Answer Box: Getting Tecentriq Covered by Blue Cross Blue Shield California Tecentriq (atezolizumab) requires prior authorization from Blue Cross Blue Shield California and is covered as a Tier 4 specialty drug for FDA-approved cancer indications. The fastest path to approval: 1) Confirm your diagnosis meets FDA-approved uses, 2) Submit a

How to Get Sumavel DosePro Covered by Aetna (CVS Health) in Washington: Complete Prior Authorization Guide

Quick Answer: Getting Sumavel DosePro Covered by Aetna (CVS Health) in Washington Sumavel DosePro requires prior authorization from Aetna CVS Health in Washington. You'll need documented failure or intolerance to oral triptans first (step therapy). Your doctor submits a PA request with clinical notes, ICD-10 codes (G43.x

How to Get Imbruvica (ibrutinib) Covered by Blue Cross Blue Shield in Ohio: Decision Tree, Forms & Appeals Process

Answer Box: Quick Path to Imbruvica Coverage Blue Cross Blue Shield Ohio covers Imbruvica (ibrutinib) with prior authorization for FDA-approved conditions including CLL/SLL and Waldenström's macroglobulinemia. Your fastest path: (1) Confirm your diagnosis matches FDA indications, (2) Have your oncologist submit a PA request with pathology reports

How to Get Mepsevii (Vestronidase Alfa) Covered by Humana in Georgia: Complete Prior Authorization Guide

Answer Box: Getting Mepsevii Covered by Humana in Georgia Mepsevii (vestronidase alfa-vjbk) requires prior authorization from Humana for MPS VII (Sly Syndrome) treatment. Success depends on confirmed diagnosis documentation and specialist involvement. The fastest path: 1) Have your metabolic specialist submit PA request with enzyme assay/genetic testing results, 2)

How to Get Trikafta (Elexacaftor/Tezacaftor/Ivacaftor) Covered by UnitedHealthcare in Florida: Complete Guide to Prior Authorization, Appeals, and State Protections

Quick Answer: Getting Trikafta Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Trikafta (elexacaftor/tezacaftor/ivacaftor) with specific criteria: patient must be 2+ years old with cystic fibrosis and have at least one F508del mutation or FDA-responsive CFTR mutation confirmed by lab testing. Submit PA through OptumRx with