Topic

Insurance Approval

A collection of 603 issues

How to Get Chenodal (chenodiol) Covered by UnitedHealthcare in Florida: Prior Authorization Forms, Appeals, and Step-by-Step Guide

Answer Box: Getting Chenodal Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Chenodial (chenodiol) and places it on a non-preferred specialty tier. Coverage is limited to cerebrotendinous xanthomatosis (CTX) with genetic confirmation—not gallstone dissolution. First step: Have your specialist submit a PA request through the UnitedHealthcare Provider

How to Get Cerezyme (Imiglucerase) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Fastest Path to Approval Cerezyme (imiglucerase) requires prior authorization from Aetna CVS Health in North Carolina. To get approved, you'll need: (1) confirmed Type 1 Gaucher disease diagnosis with enzyme testing and genetic confirmation, (2) completed Aetna Cerezyme Precertification Request Form, and (3) prescription from a

Getting Vyndaqel/Vyndamax (Tafamidis) Covered by Cigna in Ohio: Coding, Appeals, and Documentation Guide

Answer Box: Fast Track to Coverage Getting Vyndaqel/Vyndamax covered by Cigna in Ohio requires: (1) Confirmed ATTR-CM diagnosis with PYP scan or biopsy, (2) NYHA Class I-III heart failure documentation, and (3) cardiology specialist prescription. First step today: Have your cardiologist submit Cigna's prior authorization form with

Getting Prolastin-C Covered by Blue Cross Blue Shield of Michigan: PA Requirements, Appeals, and State Protections (2024-2025)

Answer Box: How to Get Prolastin-C Covered by BCBS Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Prolastin-C (alpha1-proteinase inhibitor) for commercial members, with specific criteria including confirmed alpha-1 antitrypsin deficiency, nonsmoker status, and symptomatic emphysema. Medicare Plus Blue and BCN Advantage members don't need

How to Get Zolgensma (Onasemnogene Abeparvovec) Covered by Humana in North Carolina: Complete Prior Authorization Guide

Quick Answer: Humana requires prior authorization for Zolgensma (onasemnogene abeparvovec) in North Carolina with strict age (<2 years), genetic testing, and clinical documentation requirements. Submit through Humana's provider portal with complete SMN1 testing, anti-AAV9 titers, and specialist consultation. If denied, use North Carolina's Smart NC

How to Get Eylea and Lucentis Covered by Cigna in Ohio: Complete Coding, Appeals, and Authorization Guide

Answer Box: Getting Eylea/Lucentis Covered by Cigna in Ohio Cigna requires prior authorization for Eylea (aflibercept) and Lucentis (ranibizumab) in Ohio, typically mandating bevacizumab (Avastin) step therapy first. Submit PA requests via CoverMyMeds or fax to 1-866-873-8279 with complete ICD-10 codes (H35.32_ for wet AMD, E11.3_ for

How to Get Soliris (Eculizumab) Covered by Humana in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Soliris (Eculizumab) Covered by Humana in Pennsylvania Yes, Humana covers Soliris (eculizumab) in Pennsylvania, but requires strict prior authorization. The medication typically falls under Tier 5 (specialty tier) with 25-33% coinsurance. Your fastest path to approval: 1) Ensure meningococcal vaccination is completed at least 2 weeks before

How to Get Rinvoq (upadacitinib) Covered by Blue Cross Blue Shield of Michigan: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Rinvoq Covered in Michigan Rinvoq (upadacitinib) requires prior authorization from Blue Cross Blue Shield of Michigan and is typically covered as a preferred alternative for autoimmune conditions like rheumatoid arthritis and ulcerative colitis. Your fastest path to approval: 1. Confirm formulary status: Rinvoq is covered but requires

How to Get Revcovi (Elapegademase) Covered by Aetna (CVS Health) in Washington: Complete Appeals Guide

Answer Box: Getting Revcovi Covered by Aetna in Washington Revcovi (elapegademase) requires prior authorization from Aetna (CVS Health). To get coverage in Washington: (1) Your immunologist submits a PA request with ADA-SCID genetic confirmation and documentation of failed/contraindicated bone marrow transplant, (2) If denied, file internal appeal within 30-60

Renewing Gattex (Teduglutide) Approval with Cigna in New Jersey: Complete Guide to Documentation and Deadlines

Quick Answer: Cigna requires specific renewal documentation for Gattex (teduglutide) including proof of reduced parenteral nutrition needs, lab results from the past 6 months (bilirubin, alkaline phosphatase, lipase, amylase), and colonoscopy documentation if you've been on therapy for over a year. Contact Accredo specialty pharmacy 2 weeks before