Topic

Insurance Approval

A collection of 3071 issues

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

Answer Box: Getting Firdapse Covered by Aetna CVS Health in Texas Aetna CVS Health requires prior authorization for Firdapse (amifampridine) in Texas. To get approved, you need: (1) confirmed LEMS diagnosis with EMG showing ≥60% increment or positive VGCC antibodies, (2) prescription from a neurologist/neuromuscular specialist, and (3) documentation

Work With Your Doctor to Get Rapivab (Peramivir) Approved by Aetna CVS Health in California: Complete Provider Collaboration Guide

Answer Box: Getting Rapivab Covered by Aetna CVS Health in California Rapivab (peramivir) requires prior authorization from Aetna CVS Health in California. The fastest path to approval: work closely with your doctor to submit comprehensive clinical documentation showing you meet FDA criteria (symptom onset ≤48 hours) and cannot take oral/

Work With Your Doctor to Get Somatuline Depot (Lanreotide) Approved by Blue Cross Blue Shield in Michigan: Forms, Appeals, and Success Strategies

Answer Box: Getting Somatuline Depot Covered in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Somatuline Depot (lanreotide). Approval depends on FDA-approved diagnosis (acromegaly, neuroendocrine tumors, carcinoid syndrome), documented failure of octreotide, and complete clinical documentation. First step: Have your endocrinologist or oncologist gather your treatment history

How to Get Ozempic or Mounjaro Covered by Cigna in Washington: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Ozempic or Mounjaro Covered by Cigna in Washington Eligibility: Cigna covers Ozempic (semaglutide) and Mounjaro (tirzepatide) for Type 2 diabetes with prior authorization. Coverage for weight loss varies by plan. Fastest path to approval: 1. Your doctor submits a prior authorization request through CoverMyMeds or calls 1-800-882-4462

How to Get Xospata (gilteritinib) Covered by UnitedHealthcare in Michigan: Forms, Appeals & Step-by-Step Guide

Answer Box: Getting Xospata Approved by UnitedHealthcare in Michigan Xospata (gilteritinib) requires prior authorization through OptumRx for UnitedHealthcare members in Michigan. Your oncologist must submit clinical documentation proving FLT3-mutated relapsed/refractory AML diagnosis, prior therapy history, and medical necessity via the UnitedHealthcare Provider Portal or by calling 1-800-711-4555. If denied,

Oxbryta (Voxelotor) Coverage by Blue Cross Blue Shield in Illinois: 2024 FDA Withdrawal Impact and Alternative Options

Answer Box: Oxbryta Coverage Status in Illinois Oxbryta (voxelotor) was withdrawn from the US market by FDA in September 2024 due to safety concerns. Blue Cross Blue Shield of Illinois and all insurers now automatically deny coverage as the drug is no longer FDA-approved. No appeals or bridge coverage are

How to Get Lutathera (Lutetium Lu-177 Dotatate) Covered by UnitedHealthcare in California: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Lutathera Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Lutathera (lutetium Lu-177 dotatate) with step therapy documentation showing progression on somatostatin analogs. The fastest path to approval involves: 1. Submit PA request through the UnitedHealthcare Provider Portal with SSTR-positive imaging (Ga-68 DOTATATE PET/CT), pathology

How to Get Xenpozyme (olipudase alfa-rpcp) Covered by Cigna in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Xenpozyme Covered by Cigna in Washington Xenpozyme (olipudase alfa-rpcp) requires prior authorization from Cigna for ASMD (Niemann-Pick types A/B). Your fastest path: (1) Confirm genetic diagnosis with SMPD1 variants and enzyme deficiency <10% normal, (2) Have your specialist submit PA with weight-based dosing plan via

How to Get Trikafta Covered by Blue Cross Blue Shield of Michigan: Prior Authorization Forms, Appeals, and Approval Timeline

Answer Box: Getting Trikafta Covered by BCBS Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Trikafta (elexacaftor/tezacaftor/ivacaftor), a specialty-tier medication for cystic fibrosis. Key requirements: CFTR genotype documentation, CF specialist prescription, and submission through Walgreens Specialty Pharmacy or Accredo. First step today: Have your CF

Do You Qualify for Duopa Coverage by Humana in Washington? Decision Tree & Next Steps

Answer Box: To qualify for Duopa coverage by Humana in Washington, you need advanced Parkinson's disease with documented motor fluctuations (≥3 hours daily OFF time) despite optimized oral therapy. Submit prior authorization with neurologist assessment, failed treatment history, and surgical candidacy documentation. If denied, use Humana's