Topic

Insurance Approval

A collection of 3060 issues

Getting Kanuma (Sebelipase Alfa) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Cost-Saving Guide

Answer Box: Getting Kanuma Covered in Pennsylvania Kanuma (sebelipase alfa) is typically covered by Blue Cross Blue Shield plans in Pennsylvania as a specialty drug requiring prior authorization. To get coverage: 1. Submit PA request with LAL-D diagnosis confirmation (enzyme activity test + LIPA genetic testing) 2. Use specialty pharmacy (required

Get Alprolix Covered by Humana in Texas: Prior Authorization Guide with Appeal Templates

Quick Answer: Getting Alprolix Covered by Humana in Texas Alprolix requires prior authorization from Humana and typically faces step therapy requirements. Your fastest path: 1) Have your hematologist submit a PA request with bleeding history and failed preferred alternatives, 2) Route prescriptions through CenterWell Specialty Pharmacy, 3) If denied, you

Work With Your Doctor to Get HyperHEP (Hepatitis B Immune Globulin) Approved by Blue Cross Blue Shield in Pennsylvania

Answer Box: Getting HyperHEP Covered by Blue Cross Blue Shield in Pennsylvania Blue Cross Blue Shield Pennsylvania (Highmark and Independence) requires prior authorization for HyperHEP (hepatitis B immune globulin). Your fastest path to approval: work with your doctor to submit a complete prior authorization request documenting post-exposure prophylaxis need within

Getting Orkambi (lumacaftor/ivacaftor) Covered by Cigna in North Carolina: Complete Guide to Prior Authorization, Appeals, and Templates

Quick Answer: Getting Orkambi Covered by Cigna in North Carolina Cigna requires prior authorization for Orkambi (lumacaftor/ivacaftor) with proof of homozygous F508del mutation and CF specialist prescription. If denied, you have 180 days for internal appeals, then can request external review through North Carolina's Smart NC program.

Renewing Ruconest (C1 Esterase Inhibitor) Approval with Humana in Texas: Complete Guide to Documentation and Timelines

Answer Box: Renewing Ruconest with Humana in Texas Start your renewal 30 days before expiration. Humana requires updated clinical documentation showing ongoing medical necessity for hereditary angioedema (HAE), including attack frequency reduction and treatment response. Submit via Humana's provider portal with prescriber attestation, recent clinical notes, and evidence

How to Get Amondys 45 (Casimersen) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Amondys 45 Covered by Aetna CVS Health in North Carolina Aetna CVS Health requires prior authorization for Amondys 45 (casimersen) with strict documentation: genetic testing confirming exon 45-amenable DMD mutation, age under 14, specialist prescription, and detailed monitoring plan. If denied, North Carolina residents can appeal internally

How Long Does It Take to Get Cresemba (Isavuconazole) Approved by Blue Cross Blue Shield in Pennsylvania? Complete Timeline & Appeals Guide

Answer Box: Quick Start Guide Getting Cresemba (isavuconazole) approved by Blue Cross Blue Shield in Pennsylvania typically takes 5-15 business days for standard prior authorization, or 72 hours for expedited urgent requests. Your fastest path: Have your infectious disease specialist submit a complete prior authorization through the BCBS provider portal

How to Get Uptravi (selexipag) Covered by Aetna (CVS Health) in California: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Uptravi (selexipag) Covered by Aetna (CVS Health) in California Uptravi (selexipag) requires prior authorization from Aetna (CVS Health) with strict clinical criteria. You'll need a pulmonologist or cardiologist to prescribe it, documented WHO Group I PAH diagnosis, and often proof of trying other PAH medications

How to Get Skyrizi (Risankizumab) Covered by Cigna in North Carolina: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Skyrizi (risankizumab) covered by Cigna in North Carolina requires prior authorization through Express Scripts/Accredo. Submit via CoverMyMeds portal with clinical documentation showing disease severity (PASI ≥10 or BSA ≥10% for psoriasis) and prior systemic therapy failures. If denied, appeal through Cigna's internal process, then

How to Get Firdapse (Amifampridine) Covered by Aetna CVS Health in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Firdapse Covered by Aetna CVS Health in Texas Aetna CVS Health requires prior authorization for Firdapse (amifampridine) in Texas. To get approved, you need: (1) confirmed LEMS diagnosis with EMG showing ≥60% increment or positive VGCC antibodies, (2) prescription from a neurologist/neuromuscular specialist, and (3) documentation