Topic

Insurance Approval

A collection of 879 issues

How to Get Eylea and Lucentis Covered by Blue Cross Blue Shield of Texas: Complete Prior Authorization Guide

Quick Answer: Getting Eylea/Lucentis Approved by BCBS Texas Blue Cross Blue Shield of Texas requires prior authorization for Eylea (aflibercept) and Lucentis (ranibizumab). Most plans require step therapy with bevacizumab (Avastin) first, unless contraindicated. Submit requests through Availity Essentials with OCT imaging, visual acuity records, and diagnosis documentation. Standard

Myths vs. Facts: Getting Vanflyta (Quizartinib) Covered by Humana in Georgia

Answer Box: Vanflyta Coverage by Humana in Georgia Myth-busting reality: Vanflyta (quizartinib) coverage by Humana requires prior authorization with FLT3-ITD mutation testing, EKG monitoring protocols, and often step therapy through midostaurin first. Most denials stem from missing documentation, not automatic rejections. Fastest path: Submit complete prior authorization with FLT3-ITD test

How to Get Therakos CELLEX Photopheresis Covered by Cigna in Florida: Prior Authorization, Appeals & Access Guide

Quick Answer: Getting Therakos CELLEX Covered by Cigna in Florida Therakos CELLEX photopheresis requires prior authorization from Cigna as a medical benefit procedure (not pharmacy). Submit clinical documentation showing steroid-refractory GVHD or advanced CTCL, specialist oversight, and failed conventional therapies. If denied, you have 180 days to appeal internally, followed

How to Get Amvuttra (vutrisiran) Approved by Aetna CVS Health in California: Formulary Alternatives, PA Requirements & Appeal Scripts

Answer Box: Getting Amvuttra Covered by Aetna CVS Health in California Aetna CVS Health requires prior authorization for Amvuttra (vutrisiran) with documented genetic testing, specialist evaluation, and evidence of failure/intolerance to preferred alternatives like tafamidis or patisiran. In California, standard PA decisions take 72 hours; urgent requests get 24-hour

How to Get Pomalyst (Pomalidomide) Covered by Humana in Michigan: Prior Authorization Guide & Appeal Templates

Answer Box: Getting Pomalyst (Pomalidomide) Covered by Humana in Michigan Fastest path to approval: Submit prior authorization with documented failure of both lenalidomide and a proteasome inhibitor, plus oncologist letter confirming medical necessity. If denied, file internal appeal within 65 days, then request Michigan DIFS external review within 127 days.

How to Get Carbaglu (Carglumic Acid) Covered by Blue Cross Blue Shield of North Carolina: Appeals Guide and State Protections

Answer Box: Getting Carbaglu Covered in North Carolina Carbaglu (carglumic acid) requires prior authorization from Blue Cross Blue Shield of North Carolina for confirmed NAGS deficiency. The fastest path to approval: 1. Submit complete PA request with genetic/biochemical confirmation of NAGS deficiency and elevated plasma ammonia levels 2. Include

How to Get Onivyde (Irinotecan Liposome) Covered by Humana in Washington: Prior Authorization, Appeals & Network Requirements

Answer Box: Getting Onivyde Covered by Humana in Washington Humana covers Onivyde (irinotecan liposome) in Washington, but requires prior authorization (PA) for all regimens. The NALIRIFOX combination (Onivyde + oxaliplatin + 5-FU + leucovorin) is FDA-approved for first-line metastatic pancreatic cancer as of February 2024. Fastest path to approval: 1. Submit PA request

How to Get Bavencio (Avelumab) Covered by UnitedHealthcare in New York: Prior Authorization, Appeals, and Cost Reduction Strategies

Answer Box: Getting Bavencio Covered by UnitedHealthcare in New York Bavencio (avelumab) requires prior authorization from UnitedHealthcare and is dispensed through specialty pharmacies only. In New York, if denied, you can file an external appeal with the Department of Financial Services within 4 months. First step today: Contact your oncologist

How Long Does It Take to Get Ilaris (Canakinumab) Approved by Aetna CVS Health in Texas? Complete Timeline Guide

Answer Box: Getting Ilaris (Canakinumab) Covered by Aetna CVS Health in Texas Standard approval timeline: 30-45 days for prior authorization, with over 95% of eligible requests processed within 24 hours. Expedited reviews for urgent cases must be completed within 72 hours under Texas law. Fastest path to approval: 1. Prescriber

How to Get Ferriprox (deferiprone) Covered by UnitedHealthcare in Virginia: Complete Appeals Guide

Answer Box: Getting Ferriprox Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Ferriprox (deferiprone) with step therapy requirements. Patients must typically try deferasirox or deferoxamine first unless contraindicated. To get approval: 1) Document transfusional iron overload diagnosis with ICD-10 E83.111, 2) Show prior chelator failures or contraindications,