Topic

Insurance Approval

A collection of 2917 issues

How to Get Ferriprox (deferiprone) Covered by Humana in Washington: Prior Authorization Guide with Appeal Scripts

Answer Box: Getting Ferriprox Covered by Humana in Washington Ferriprox (deferiprone) requires prior authorization from Humana and is typically non-formulary, but approval is possible with proper documentation. The fastest path: 1) Confirm your plan type and verify Ferriprox's formulary status via Humana's drug lookup tool, 2)

Get Soliris (Eculizumab) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization Guide

Answer Box: Fastest Path to Soliris Coverage Getting Soliris (eculizumab) covered by Aetna CVS Health in North Carolina requires meeting strict diagnostic criteria and completing mandatory vaccinations. Step 1: Confirm your diagnosis with required lab tests (flow cytometry for PNH, anti-AChR antibodies for myasthenia gravis). Step 2: Complete meningococcal vaccination

Getting Zanzalintinib (XL092) Covered by Cigna in Pennsylvania: Complete Coding and Appeals Guide

Answer Box: Your Path to Coverage Zanzalintinib (XL092) is an investigational cancer drug requiring special approval from Cigna. In Pennsylvania, you'll need: (1) Your doctor submits a prior authorization with clinical trial documentation or compassionate use approval from Exelixis, (2) if denied, file internal appeals within 180 days,

How to Get Photrexa Covered by Cigna in Ohio: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Photrexa Covered by Cigna in Ohio Yes, Cigna covers Photrexa (riboflavin ophthalmic solution) for FDA-approved epithelium-off corneal cross-linking in progressive keratoconus. Your ophthalmologist must submit prior authorization through Cigna's provider portal with documented progression evidence (Kmax increase ≥1.0D, pachymetry thinning, topography changes over 3-12

How Long Does It Take to Get Humira Approved by Blue Cross Blue Shield in Michigan? Complete Timeline & Appeal Guide

Answer Box: Getting Humira Approved by BCBS Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Humira, with decisions typically made within 15 calendar days (72 hours for urgent cases). The fastest path involves: 1) Complete TB/hepatitis B screening, 2) Try preferred biosimilars first (step therapy), and

Myths vs. Facts: Getting Opfolda (miglustat) Covered by Aetna (CVS Health) in North Carolina

Answer Box: Getting Opfolda Covered by Aetna in North Carolina Opfolda (miglustat) requires prior authorization from Aetna (CVS Health) when used with Pombiliti for late-onset Pompe disease (LOPD). The fastest path to approval: 1) Submit precertification via Availity portal with complete LOPD diagnosis documentation and ERT failure history, 2) Include

How to Get Evkeeza (evinacumab-dgnb) Covered by Humana in Michigan: Prior Authorization Forms, Appeal Timelines & Scripts

Quick Answer: Getting Evkeeza Covered by Humana in Michigan Evkeeza (evinacumab-dgnb) requires prior authorization from Humana and is covered under your medical benefit, not pharmacy benefit, since it's given by IV infusion. Your fastest path to approval: 1) Confirm HoFH diagnosis with genetic testing or clinical criteria, 2)

How to Get Alprolix Covered by Blue Cross Blue Shield in Pennsylvania: PA Forms, Appeals & Success Strategies

Answer Box: Getting Alprolix Covered by BCBS in Pennsylvania Alprolix requires prior authorization from all Blue Cross Blue Shield plans in Pennsylvania. The fastest path to approval: (1) Have your hematologist submit a PA request through the BCBS provider portal with documentation of hemophilia B diagnosis, factor IX levels <

How to Get Isturisa (Osilodrostat) Covered by UnitedHealthcare in Ohio: Complete Prior Authorization Guide

Answer Box: Getting Isturisa Covered by UnitedHealthcare in Ohio Fastest path to approval: UnitedHealthcare requires prior authorization for Isturisa (osilodrostat) with documented Cushing's disease and proof that surgery isn't an option or wasn't curative. No step therapy is required if these criteria are met.

Getting Pombiliti (Cipaglucosidase Alfa) Covered by Cigna in Pennsylvania: Prior Authorization, Appeals, and Cost-Saving Strategies

Quick Answer: Getting Pombiliti Covered by Cigna in Pennsylvania Cigna requires prior authorization for Pombiliti (cipaglucosidase alfa-atga) and places it on Tier 5 specialty formulary. First step: Have your prescriber submit PA through CoverMyMeds or ExpressPAth with genetic confirmation of Pompe disease and documentation that you're not improving