Topic

Insurance Approval

A collection of 817 issues

How to Get Acthar Gel Covered by Cigna in Michigan: Prior Authorization, Appeals, and Formulary Alternatives Guide

Answer Box: Getting Acthar Gel Covered by Cigna in Michigan Cigna requires prior authorization and step therapy for Acthar Gel (repository corticotropin injection) in Michigan. You'll need documented failure or contraindication to preferred alternatives like prednisone or IV methylprednisolone. If denied, Michigan gives you 127 days to file

How to Get Nucala (Mepolizumab) Covered by Aetna CVS Health in New York: Complete Guide with Forms and Appeal Process

Answer Box: Getting Nucala Covered by Aetna CVS Health in New York Yes, Nucala (mepolizumab) can be covered by Aetna CVS Health in New York, but requires prior authorization. You'll need a blood eosinophil count ≥150 cells/µL, documented failure of high-dose inhaled steroids plus another controller, and

Get Rebif (Interferon Beta-1a) Covered by Cigna in Virginia: Forms, Appeals & State Resources

Answer Box: Getting Rebif Approved by Cigna in Virginia To get Rebif (interferon beta-1a) covered by Cigna in Virginia, your doctor must submit a prior authorization through CoverMyMeds or SureScripts, including recent CBC and liver function tests, your MS diagnosis details, and documentation of any prior DMT failures. If denied,

Renewing Naglazyme (Galsulfase) Coverage with Humana in Ohio: 2025 Requirements and Timeline

Answer Box: Renewing Naglazyme Coverage with Humana Naglazyme (galsulfase) requires prior authorization renewal every 6-12 months with Humana in Ohio. Start your renewal 30 days before expiration to avoid therapy interruption. Submit updated clinical documentation showing ongoing benefit through Humana's provider portal or fax to 1-877-486-2621. If denied,

How to Get Vyndaqel/Vyndamax (Tafamidis) Covered by Aetna CVS Health in North Carolina: Complete Guide to Prior Authorization, Appeals, and External Review

Answer Box: Getting Tafamidis Covered by Aetna CVS Health in North Carolina Quick Path to Approval: Aetna requires prior authorization for both Vyndaqel and Vyndamax (tafamidis) with confirmed ATTR-CM diagnosis via PYP scan or biopsy, NYHA Class I-III symptoms, and specialist prescriber. First step today: Verify your 2025 formulary status—

Renewing Fabrazyme (Agalsidase Beta) Coverage with Aetna in Virginia: Timeline, Documentation, and Bridge Options

Answer Box: Fabrazyme Renewal with Aetna in Virginia Key Steps: (1) Submit renewal documentation 30 days before current authorization expires, (2) Include updated specialist evaluation and lab results showing continued medical necessity, (3) Use Aetna's provider portal or fax to submit required forms. Timeline: Standard decisions within 14

How to Get Elaprase (Idursulfase) Covered by Humana in New York: Complete Appeals Guide

Answer Box: Get Elaprase Covered by Humana in New York Elaprase (idursulfase) requires prior authorization from Humana Medicare plans. Your fastest path to approval: (1) Have your doctor submit enzymatic/genetic test results confirming Hunter syndrome via Humana's provider portal or fax to 877-486-2621, (2) Include weight-based dosing

UnitedHealthcare's Coverage Criteria for Keytruda in Washington: What Counts as "Medically Necessary"?

Answer Box: Getting Keytruda Covered by UnitedHealthcare in Washington To get Keytruda (pembrolizumab) covered by UnitedHealthcare in Washington, you need prior authorization with specific biomarker testing results (PD-L1 CPS ≥1, MSI-H, or TMB-H ≥10 mutations/megabase for most indications). Submit through the UnitedHealthcare Provider Portal with complete pathology reports, clinical

How to Get Rezlidhia (Olutasidenib) Covered by Cigna in Georgia: Appeals, Forms, and Timeline Guide

Quick Answer: Getting Rezlidhia Covered by Cigna in Georgia Cigna requires prior authorization for Rezlidhia (olutasidenib) with strict criteria: patient must be 18+, have relapsed/refractory AML, and documented IDH1 mutation via FDA-approved test. If denied, you have 180 days to appeal internally, then can request Georgia's external

How to Get Breyanzi Covered by UnitedHealthcare in California: Complete Prior Authorization Guide

Quick Answer: Getting Breyanzi Approved by UnitedHealthcare in California Breyanzi (lisocabtagene maraleucel) requires prior authorization from UnitedHealthcare before administration. To get approval: (1) Submit a complete PA request through the UnitedHealthcare Provider Portal with diagnosis documentation, prior therapy records, and REMS facility certification; (2) Allow 72 hours for standard review