Topic

Insurance Approval

A collection of 826 issues

Work With Your Doctor to Get Epidiolex (Cannabidiol) Covered by Cigna in Washington: Complete Provider Collaboration Guide

Answer Box: Getting Cigna to Cover Epidiolex in Washington To get Epidiolex (cannabidiol) covered by Cigna in Washington, you need prior authorization with documented diagnosis of Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex, plus evidence of failed alternative seizure medications. Your neurologist must complete Cigna's PA form
7 min read

How to Get Elevidys (Delandistrogene Moxeparvovec-Rokl) Covered by Humana in Michigan: Forms, Appeals, and State Protections

Quick Answer: Getting Elevidys Covered by Humana in Michigan Elevidys requires prior authorization from Humana Medicare Advantage plans. Your fastest path: 1) Gather DMD genetic testing, prior steroid therapy records, and functional assessments; 2) Have your prescriber submit a complete PA request with medical necessity documentation; 3) If denied, file
5 min read

How to Get Ibrance (Palbociclib) Covered by UnitedHealthcare in Florida: Complete PA Guide & Appeal Scripts

Quick Answer: Getting Ibrance Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Ibrance (palbociclib) in Florida through their OptumRx specialty pharmacy program. Fastest path to approval: Submit PA through the UnitedHealthcare Provider Portal's Cancer Guidance Program with documented HR+/HER2- metastatic breast cancer diagnosis and combination
6 min read

Tegsedi (Inotersen) Approval with UnitedHealthcare in Georgia: Answers to the Most Common Questions

Answer Box: Getting Tegsedi Covered by UnitedHealthcare in Georgia Yes, UnitedHealthcare covers Tegsedi (inotersen) for hereditary transthyretin-mediated (hATTR) amyloidosis with polyneuropathy in adults, but requires prior authorization. The fastest path to approval: (1) Enroll in the Tegsedi REMS program immediately, (2) Document genetic TTR mutation and prior Onpattro trial/failure,
5 min read

Do You Qualify for Enhertu Coverage by UnitedHealthcare in Georgia? Decision Tree & Next Steps

Answer Box: Your Path to Enhertu Coverage in Georgia UnitedHealthcare requires prior authorization for Enhertu (fam-trastuzumab deruxtecan) in Georgia. To qualify, you need documented HER2-positive status, appropriate diagnosis (breast, lung, or gastric cancer), and typically evidence of prior HER2-targeted therapy failure. Submit requests through the UnitedHealthcare Provider Portal with complete
5 min read

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

Answer Box: Getting Dojolvi Covered by Aetna CVS Health in Texas Dojolvi (triheptanoin) requires prior authorization from Aetna CVS Health and is not on the 2024 formulary, requiring a formulary exception. Essential requirements include genetic/biochemical LC-FAOD confirmation, specialist documentation, and proof that dietary management alone is inadequate. First step
5 min read

How to Get Ilaris (Canakinumab) Approved by UnitedHealthcare in California: Timeline, Appeals & Success Strategies

Quick Answer: Getting Ilaris Approved by UnitedHealthcare in California Yes, UnitedHealthcare covers Ilaris (canakinumab) with prior authorization for FDA-approved conditions including Still's disease, periodic fever syndromes, and refractory gout. The fastest path: Have your rheumatologist submit a complete PA request through the UnitedHealthcare provider portal with documented step
7 min read