Topic

Insurance Approval

A collection of 765 issues

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

How to Get Enbrel (etanercept) Covered by Cigna in Michigan: Complete Prior Authorization Guide

Answer Box: Getting Enbrel Covered by Cigna in Michigan Eligibility: Cigna covers Enbrel (etanercept) for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis with prior authorization. You must be over 18, prescribed by a rheumatologist, and have tried another biologic (excluding etanercept biosimilars). Fastest path: Your doctor submits a

Renewing Givlaari (givosiran) Approval with Cigna in Illinois: Complete Guide to Documentation, Timelines, and Appeals

Quick Answer: Givlaari (givosiran) renewal with Cigna requires annual documentation showing reduced attack frequency, ongoing specialist care, and absence of serious toxicity. Submit renewal requests 2-4 weeks before your current approval expires. If denied, you have 180 days for internal appeals and 30 days for Illinois external review. Start gathering

How to Get Tepezza (Teprotumumab) Covered by Aetna CVS Health in Washington: Prior Authorization Forms, Appeal Process & Success Strategies

Answer Box: Getting Tepezza Covered by Aetna CVS Health in Washington Fastest path to approval: Your ophthalmologist submits Aetna's Tepezza Precertification Form with documented moderate-to-severe TED diagnosis and evidence of failed step therapy (prednisone, methimazole). If denied, file internal appeals within 180 days, then request external review through

Getting Vitrakvi (Larotrectinib) Covered by Cigna in New Jersey: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Vitrakvi (Larotrectinib) Covered by Cigna in New Jersey Eligibility: Cigna requires prior authorization for Vitrakvi (larotrectinib) with documented NTRK gene fusion, unresectable/metastatic solid tumors, and oncologist prescribing. Fastest path: Submit PA request via CoverMyMeds portal with NTRK fusion test results, prior therapy documentation, and medical necessity

How to Get Alprolix Covered by Aetna CVS Health in New York: Formulary Status, Appeals Process & PA Requirements

Quick Answer: Getting Alprolix Covered by Aetna CVS Health in New York Challenge: Alprolix is excluded from Aetna's 2024 Advanced Control Formulary, meaning routine prior authorization isn't available. Path forward: Request a coverage exception with strong medical necessity documentation from your hematologist. First step today: Contact

How to Get Cystadane (Betaine Anhydrous) Covered by Cigna in Texas: Complete Guide to Prior Authorization, Appeals, and Approval

Answer Box: Getting Cystadane Covered by Cigna in Texas Eligibility: Cigna covers Cystadane (betaine anhydrous) for homocystinuria due to CBS, MTHFR, or cobalamin metabolism defects with prior authorization. Fastest approval path: Submit complete documentation including genetic/enzyme testing, vitamin therapy trial records, and specialist oversight from a metabolic/genetic disease

Get Photrexa (Riboflavin) Covered by Cigna in Washington: Complete Appeals Guide with Forms and Deadlines

Answer Box: Getting Photrexa Covered by Cigna in Washington Cigna requires prior authorization for Photrexa (riboflavin ophthalmic solution) as part of corneal cross-linking for progressive keratoconus. To get approval: 1. Submit PA electronically via CoverMyMeds or Cigna Provider Portal with documented progression evidence (Kmax increase ≥1.0 D, serial topography)

How to Get Myozyme (alglucosidase alfa) Covered by Blue Cross Blue Shield of Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Myozyme Covered by BCBS Illinois Blue Cross Blue Shield of Illinois requires prior authorization for Myozyme (alglucosidase alfa) for Pompe disease treatment. The fastest path to approval involves three key steps: (1) Submit complete diagnostic documentation including GAA enzyme assay and genetic testing results, (2) Have your

Getting Trikafta Covered by Cigna in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Trikafta Coverage To get Trikafta covered by Cigna in Washington: 1) Confirm your CFTR genetic testing shows an FDA-approved mutation, 2) Have your CF specialist submit a prior authorization with baseline labs and medical necessity letter, 3) If denied, file an internal appeal within 180