Topic

Insurance Approval

A collection of 2914 issues

How to Get Mycapssa (Octreotide) Covered by Aetna CVS Health in Ohio: Complete Prior Authorization Guide

Answer Box: Getting Mycapssa Covered by Aetna CVS Health in Ohio Mycapssa (oral octreotide) requires prior authorization from Aetna CVS Health and is only approved for acromegaly patients who have already responded to injectable octreotide or lanreotide. The fastest path to approval: 1) Gather documentation of your prior response to

How to Get Photrexa (Riboflavin) Approved by Humana in Pennsylvania: Timeline, Appeals & Success Strategies

Answer Box: Getting Photrexa Covered by Humana in Pennsylvania Humana requires prior authorization for Photrexa (riboflavin ophthalmic solution) used in corneal cross-linking for keratoconus. The fastest path to approval: gather documented progression evidence (Kmax increase ≥1.0 diopter, serial topography), submit through Humana's electronic PA system for 1-day

How Long Does It Take to Get Vigabatrin (Sabril) Approved by Aetna CVS Health in Georgia? Complete Timeline Guide

Answer Box: Getting Vigabatrin Approved by Aetna CVS Health in Georgia Standard timeline: 7 days for routine requests, 72 hours for urgent cases. The fastest path requires complete REMS enrollment, baseline vision testing documentation, and specialist involvement. Most approvals happen within 24 hours when submitted electronically with all required documents.

How to Get Brensocatib (BRINSUPRI) Covered by Blue Cross Blue Shield in Ohio: Cost Reduction, Appeals & Patient Assistance

Answer Box: Getting Brensocatib (BRINSUPRI) Covered in Ohio Blue Cross Blue Shield Ohio will likely require prior authorization for Brensocatib (BRINSUPRI) and place it on a specialty tier (Tier 4-5) given its ~$88,000 annual list price. First steps: Verify your plan's formulary status, gather documentation of 2+

Getting Imbruvica (Ibrutinib) Covered by Aetna CVS Health in Virginia: Forms, Appeals, and Step Therapy Rights

Quick Answer: Your Path to Approval Imbruvica (ibrutinib) requires prior authorization from Aetna CVS Health but no step therapy for CLL/SLL. In Virginia, you have strong appeal rights: 72-hour step therapy override decisions, 180 days to appeal denials, and external review through the State Corporation Commission using Form 216-A.

Renewing Vanflyta (Quizartinib) Coverage with UnitedHealthcare in Illinois: Timeline, Documentation & Appeal Process

Quick Answer: Renewing Vanflyta Coverage with UnitedHealthcare in Illinois UnitedHealthcare requires 12-month renewals for Vanflyta (quizartinib) with documentation showing no disease progression. Start renewal 30-60 days before expiration. Submit: updated labs, imaging, clinical notes proving treatment response, and EKG/QTc monitoring records through the UHC Provider Portal. If denied, file

How to Get Duopa (Carbidopa/Levodopa Enteral) Covered by Cigna in Michigan: Timeline, Appeals, and Approval Guide

Answer Box: Getting Duopa Covered by Cigna in Michigan Cigna requires prior authorization for Duopa (carbidopa/levodopa enteral) in Michigan. Approval typically takes 15 days for standard requests, 72 hours for urgent cases. Key requirements: advanced Parkinson's diagnosis, documented "off" episodes, failed trials of extended-release carbidopa/

How to Get Lamzede (velmanase alfa-tycv) Covered by Humana in Michigan: Timeline, Appeals, and Approval Steps

Answer Box: Getting Lamzede Covered by Humana in Michigan Fastest path to approval: Submit Humana's prior authorization request with confirmed alpha-mannosidosis diagnosis (enzyme assay or MAN2B1 genetic testing), complete clinical documentation, and evidence of medical necessity. Timeline: 5 business days for standard review, 48 hours for expedited. First

How to Get Zolgensma Covered by Aetna CVS Health in Michigan: Complete Appeals Guide with Forms and Deadlines

Answer Box: Getting Zolgensma Covered by Aetna CVS Health in Michigan Fastest path to approval: Submit prior authorization through Aetna's provider portal with genetic confirmation of SMA, age verification (under 2 years), and detailed medical necessity letter. If denied, file internal appeal within 60 days, then request expedited

How to Get Arikayce Covered by UnitedHealthcare in Florida: Prior Authorization, Appeals, and Step Therapy Exceptions

Answer Box: Getting Arikayce Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Arikayce (amikacin liposome inhalation) in Florida with strict medical necessity criteria. To get approved: 1. Document 6+ months of failed multidrug MAC therapy with persistent positive cultures 2. Submit OptumRx prior authorization via professionals.optumrx.com