Topic

Insurance Approval

A collection of 764 issues

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

How to Get Gamifant (Emapalumab-lzsg) Covered by Humana in Virginia: Complete Guide with Forms and Appeal Process

Quick Answer: Getting Gamifant (Emapalumab-lzsg) Covered by Humana in Virginia Fastest path to approval: Have your hematologist submit a prior authorization request to Humana with documented HLH-2004 criteria (5 of 8 required), genetic testing or family history, and evidence of conventional therapy failure. Submit via fax to 502-508-9300 with complete

How to Get Qalsody (Tofersen) Covered by Humana in Georgia: Complete Prior Authorization Guide

Answer Box: Getting Qalsody (Tofersen) Covered by Humana in Georgia Eligibility: Qalsody requires confirmed ALS with documented SOD1 mutation, neurologist prescriber, and baseline ALSFRS-R/vital capacity testing. Fastest approval path: Submit complete prior authorization with genetic testing results, clinical notes, and baseline assessments through Humana's provider portal or

How to Get Keytruda (Pembrolizumab) Covered by Blue Cross Blue Shield in Ohio: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Keytruda Covered in Ohio Keytruda (pembrolizumab) requires prior authorization from Blue Cross Blue Shield in Ohio. The fastest path to approval involves three steps: 1) Gather biomarker test results (PD-L1, MSI-H, or TMB-H as required by your cancer type), 2) Submit complete prior authorization through your provider&

How to Get Thiola / Thiola EC (Tiopronin) Covered by Humana in New York: Appeals, Timelines, and State Protections

Answer Box: Fast Track to Thiola Coverage Getting Thiola/Thiola EC approved by Humana in New York requires three key steps: First, ensure your prescriber documents failed conservative treatments (hydration, alkalinization) and includes a 24-hour urine cystine level showing elevated excretion. Second, if denied, file an internal appeal within 65

Complete Guide: Getting Busulfex (Busulfan Injection) Covered by Aetna in New York - Prior Authorization, Appeals & Forms

Answer Box: Getting Busulfex Covered by Aetna in New York Busulfex (busulfan injection) requires prior authorization from Aetna for transplant conditioning in chronic myeloid leukemia. The fastest path to approval involves three key steps: (1) Confirm your transplant center is an Aetna Institute of Excellence facility, (2) Have your transplant

How to Get Strensiq (Asfotase Alfa) Covered by Cigna in North Carolina: Complete PA Guide and Appeals Strategy

Answer Box: Getting Strensiq Covered by Cigna in North Carolina Strensiq (asfotase alfa) requires prior authorization from Cigna and is typically covered only for pediatric-onset hypophosphatasia with strict documentation requirements. Your fastest path to approval: (1) Work with an HPP specialist to gather genetic testing, low ALP levels, and clinical

If Pemazyre (Pemigatinib) Isn't Approved by Aetna CVS Health in Ohio: Formulary Alternatives & Exception Paths

Answer Box: Fast Track to Pemazyre Coverage If Aetna CVS Health denies Pemazyre (pemigatinib) in Ohio, you have three main paths: formulary exception request (if non-formulary), prior authorization appeal (if denied for medical necessity), or trying alternative FGFR inhibitors first. Most denials stem from missing FGFR2 fusion test results or