Topic

Insurance Approval

A collection of 6349 issues

How to Get Keytruda (Pembrolizumab) Covered by Cigna in North Carolina: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Started in North Carolina Keytruda (pembrolizumab) requires prior authorization from Cigna in North Carolina. Your fastest path to approval: 1) Download Cigna's Keytruda PA form, 2) Ensure your oncologist documents required biomarkers (PD-L1 CPS, MSI-H/TMB-H where applicable) and prior therapy failures, 3) Submit via

How to Get Waylivra (Volanesorsen) Covered by Cigna in Pennsylvania: Appeals Guide and PA Requirements

Answer Box: Getting Waylivra Covered by Cigna in Pennsylvania Waylivra (volanesorsen) is not FDA-approved in the U.S., making Cigna coverage extremely unlikely without comprehensive appeals. Your fastest path: 1) Have an endocrinologist/lipidologist submit a medical necessity appeal with genetic FCS confirmation and triglycerides ≥880 mg/dL, 2) Request

How to Get Zolgensma Covered by Cigna in Michigan: Complete Prior Authorization and Appeal Guide (2024)

Answer Box: Getting Zolgensma Covered by Cigna in Michigan Cigna covers Zolgensma (onasemnogene abeparvovec) for spinal muscular atrophy (SMA) in Michigan with prior authorization requiring genetic confirmation of bi-allelic SMN1 mutations, age under 2 years, anti-AAV9 titer ≤1:50, and recent labs (creatinine <1.0 mg/dL, hemoglobin 8-18

How to Renew Keppra (Levetiracetam) Approval with Cigna in Georgia: Timeline, Evidence & Bridge Options

Answer Box: Renewing Keppra (Levetiracetam) with Cigna in Georgia Generic levetiracetam typically requires no prior authorization renewal, while brand Keppra requires ongoing documentation. Start your renewal 30-45 days before your current approval expires. Submit seizure frequency logs, adherence records, and updated medical necessity documentation through your prescriber. If coverage lapses,

How to Renew Naglazyme (Galsulfase) Coverage with Cigna in Georgia: Timeline, Documents, and Emergency Bridge Options

Answer Box: Renewing Naglazyme (Galsulfase) Coverage with Cigna in Georgia Start your Naglazyme renewal 2-3 weeks before your current prior authorization expires. Cigna requires annual renewal with documented clinical response (6-minute walk test improvements, reduced urinary GAG levels) and specialist confirmation. Submit through Express Scripts or your prescriber's

UnitedHealthcare's Coverage Criteria for Tremfya in California: What Counts as "Medically Necessary"?

Answer Box: Getting Tremfya Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Tremfya (guselkumab) with step therapy through TNF inhibitors first, documented disease severity (PASI ≥12 or BSA ≥10%), and negative TB screening within 12 months. If denied, California's Independent Medical Review (IMR) has a 73%

How to Get Humate-P Covered by Aetna (CVS Health) in North Carolina: Prior Authorization Guide and Appeal Scripts

Answer Box: Quick Path to Humate-P Coverage To get Humate-P covered by Aetna (CVS Health) in North Carolina: Submit prior authorization with hematologist consultation, document von Willebrand disease subtype or hemophilia A severity, and prove desmopressin failure/intolerance (step therapy requirement). If denied, you have 180 days to appeal internally,

How to Get Brineura (cerliponase alfa) Covered by Humana in California: PA Forms, Appeals, and Exception Paths

Quick Answer: Getting Brineura Covered by Humana in California Brineura (cerliponase alfa) requires prior authorization from Humana for pediatric CLN2 patients ≥3 years. Submit Humana's "Request for Medicare Prescription Drug Coverage Determination" with prescriber documentation proving CLN2 diagnosis, specialized center capability, and medical necessity. Standard decisions

Renewing Uplizna (Inebilizumab) Approval with Aetna CVS Health in North Carolina: Timeline, Evidence, and Lapse Prevention

Answer Box: Renewing Uplizna Coverage with Aetna CVS Health Uplizna (inebilizumab) renewal with Aetna CVS Health in North Carolina requires prior authorization submission 30-60 days before current approval expires. Key evidence: documented clinical response (no relapses for NMOSD, organ stability for IgG4-RD), current specialist evaluation, safety labs (immunoglobulins, B-cell counts)

How to Get Pemazyre (Pemigatinib) Covered by Cigna in Pennsylvania: Prior Authorization Forms, Appeals, and Coding Guide

Answer Box: Getting Pemazyre Covered by Cigna in Pennsylvania Eligibility: Adults with FGFR2-positive cholangiocarcinoma or FGFR1-positive myeloid/lymphoid neoplasms who've tried prior therapy. Fastest path: Submit Cigna's prior authorization with FGFR test results and ophthalmologic monitoring plan. First step today: Contact your oncologist to order FGFR