Topic

Insurance Approval

A collection of 832 issues

How to Get Eylea or Lucentis Covered by Blue Cross Blue Shield in Illinois: Complete Appeals Guide

Quick Answer: Getting Eylea or Lucentis Approved in Illinois Blue Cross Blue Shield of Illinois requires prior authorization for Eylea (aflibercept) and Lucentis (ranibizumab) under most Medicare Advantage and government plans as of 2024. You'll likely need to try bevacizumab (Avastin) first due to step therapy requirements. Your

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

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

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

How to Get Vitrakvi (Larotrectinib) Covered by Aetna CVS Health in Texas: Complete Coverage and Appeal Guide

Answer Box: Getting Vitrakvi Covered by Aetna CVS Health in Texas Vitrakvi (larotrectinib) requires prior authorization with Aetna CVS Health in Texas and documentation of a positive NTRK gene fusion test. The fastest path to approval: (1) Ensure your oncologist has your NTRK fusion test results ready, (2) Submit the

How to Get Entresto (Sacubitril/Valsartan) Covered by Cigna in North Carolina: Prior Authorization Forms, Appeals, and Coding Guide

Quick Answer: Getting Entresto Covered by Cigna in North Carolina Cigna requires prior authorization for Entresto (sacubitril/valsartan) in 2024. You'll need documentation of heart failure diagnosis (ICD-10 I50.22), proof of ACE inhibitor or ARB failure/intolerance, and clinical justification. Submit PA requests via Cigna's

How to Get Berinert (C1-esterase inhibitor, IV) Covered by Humana in Washington: Complete Prior Authorization Guide

Answer Box: Getting Berinert Covered by Humana in Washington Humana requires prior authorization for Berinert (C1-esterase inhibitor, IV) for hereditary angioedema treatment. The fastest path to approval: (1) Submit PA request through CoverMyMeds with complete HAE diagnosis documentation, (2) Include evidence of failed alternative therapies or contraindications, and (3) Use

Myths vs. Facts: Getting Epidiolex (Cannabidiol) Covered by Humana in Texas

Answer Box: Getting Epidiolex Covered by Humana in Texas Myth: "If denied, you can't get Epidiolex." Fact: Humana requires prior authorization for Epidiolex in Texas, but denials are often overturned with proper documentation. Success requires: (1) confirmed diagnosis of LGS, Dravet syndrome, or TSC, (2) documented

How to Get Cometriq (Cabozantinib) Covered by Humana in Illinois: Prior Authorization, Appeals, and Coding Guide

Answer Box: Getting Cometriq (Cabozantinib) Covered by Humana in Illinois Cometriq requires prior authorization from Humana for medullary thyroid carcinoma (MTC). The fastest path: Your oncologist submits clinical documentation with ICD-10 code C73, pathology confirming MTC, and prior treatment history to Humana's provider portal or fax 877-486-2621. If

How to Get Raxone (Idebenone) Covered by UnitedHealthcare in Pennsylvania: Prior Authorization, Appeals & Cost-Saving Strategies

Quick Answer: Raxone (idebenone) is not FDA-approved in the U.S., making UnitedHealthcare coverage extremely difficult. However, you can pursue coverage through: (1) Prior authorization with medical necessity documentation for off-label use, (2) Step therapy exceptions if alternatives failed, and (3) Pennsylvania's external review process, which overturns ~50%