Topic

Insurance Approval

A collection of 751 issues

How to Get Eylea and Lucentis Covered by UnitedHealthcare in Texas: Prior Authorization Forms, Appeals, and Step Therapy Guide

Answer Box: Getting Started in Texas UnitedHealthcare requires prior authorization for both Eylea (aflibercept) and Lucentis (ranibizumab) in Texas, with step therapy typically requiring bevacizumab first unless contraindicated. Both drugs are placed in Tier 4 (Specialty) with higher copays or coinsurance. Fastest approval path: (1) Have your retina specialist submit

How to Get Onpattro (patisiran) Covered by Blue Cross Blue Shield in Florida: Complete Guide with Forms and Appeal Templates

Answer Box: Getting Onpattro Covered in Florida Eligibility: Blue Cross Blue Shield Florida covers Onpattro (patisiran) for hereditary transthyretin-mediated amyloidosis (hATTR) with polyneuropathy in adults 18+ with confirmed TTR gene mutation and specialist evaluation. Fastest path: Gather genetic testing, neurologist consultation, and baseline scores (mNIS+7, 6MWT) before submitting prior

How to Get Tracleer (Bosentan) Covered by Blue Cross Blue Shield in California: Complete Prior Authorization Guide

Answer Box: Getting Tracleer Covered in California To get Tracleer (bosentan) covered by Blue Cross Blue Shield in California: 1. Confirm eligibility: You need WHO Group 1 PAH, specialist prescription, and NYHA Class II-IV symptoms 2. Complete REMS enrollment: Both you and your doctor must enroll in the mandatory bosentan

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

Answer Box: Getting Photrexa Covered by Aetna CVS Health in Ohio Aetna CVS Health covers epithelium-off corneal cross-linking with Photrexa for progressive keratoconus and ectasia. The fastest path to approval: 1) Verify your plan covers CPT code 0402T, 2) Submit prior authorization with documented keratoconus progression (serial topography, Kmax increases)

How to Get Ibrance (Palbociclib) Covered by Humana in Florida: Complete Decision Tree and Appeals Guide

Answer Box: Getting Ibrance (Palbociclib) Covered by Humana in Florida You'll likely qualify if you have HR+/HER2- advanced breast cancer with proper pathology documentation. Humana requires prior authorization for Ibrance, typically processed within 2-3 business days with complete documentation. Your first step today: Gather your pathology reports

How to Get Kanuma (Sebelipase Alfa) Covered by Aetna (CVS Health) in Ohio: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Kanuma Covered by Aetna in Ohio Kanuma (sebelipase alfa) requires prior authorization from Aetna (CVS Health) for LAL-D patients. The fastest path: your doctor submits a prior authorization request through Aetna's Availity portal with LAL enzyme activity test results, genetic confirmation, and documented hepatic/lipid

How to Get Eloctate Covered by Humana in Texas: Complete Prior Authorization Guide with Forms and Appeals

Answer Box: Getting Eloctate Covered by Humana in Texas Eloctate (efmoroctocog alfa) requires prior authorization from Humana in Texas for all plan types. The fastest path: Have your hematologist submit a PA request with complete clinical documentation via Humana's provider portal or fax to 877-486-2621. Include diagnosis, factor

How to Get Revlimid (Lenalidomide) Covered by UnitedHealthcare in California: A Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Revlimid Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Revlimid (lenalidomide) through OptumRx, with strict clinical criteria and REMS compliance. The fastest path to approval: (1) Ensure your oncologist submits a complete prior authorization with lab values, diagnosis codes, and treatment history through the UnitedHealthcare

Myths vs. Facts: Getting Koselugo (Selumetinib) Covered by Blue Cross Blue Shield in Michigan - Appeals Guide 2025

Answer Box: Getting Koselugo Covered in Michigan Eligibility: Blue Cross Blue Shield of Michigan covers Koselugo for pediatric patients (ages 2-18) with NF1 and symptomatic, inoperable plexiform neurofibromas requiring prior authorization. Fastest Path: Submit complete PA with baseline LVEF (echocardiogram), ophthalmologic exam, NF1 diagnosis confirmation, and tumor imaging showing inoperability.

If Keytruda Isn't Approved by Blue Cross Blue Shield in Texas: Formulary Alternatives & Exception Paths

Quick Answer: If Blue Cross Blue Shield of Texas denies Keytruda (pembrolizumab), formulary alternatives include Opdivo (nivolumab), Tecentriq (atezolizumab), Imfinzi (durvalumab), and Libtayo (cemiplimab). Submit a Prescription Drug Coverage Exception form with detailed medical documentation showing why preferred drugs failed or are contraindicated. Internal appeals have 72-hour decisions, with external