Topic

Insurance Approval

A collection of 5272 issues

How to Get Kymriah (tisagenlecleucel) Covered by Blue Shield of California: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Kymriah Covered by Blue Shield of California Blue Shield of California covers Kymriah (tisagenlecleucel) for eligible patients with relapsed/refractory B-cell ALL and lymphomas, requiring prior authorization with medical records submission. To get approved: (1) Ensure you meet the medical necessity criteria including CD19-positive disease and 2+

Get Pomalyst (Pomalidomide) Covered by Blue Cross Blue Shield in New York: Complete Appeals Guide

Answer Box: Fastest Path to Pomalyst Coverage Pomalyst (pomalidomide) requires prior authorization from Blue Cross Blue Shield plans in New York. Success depends on documenting progression after ≥2 prior therapies including lenalidomide and a proteasome inhibitor, REMS program enrollment, and oncologist prescription with dexamethasone combination. If denied, New York'

How to Get Opsumit (Macitentan) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Opsumit Approved by Aetna CVS Health in North Carolina Opsumit (macitentan) requires prior authorization from Aetna CVS Health for pulmonary arterial hypertension (PAH) treatment. The fastest path: (1) Complete the Aetna Rx PA form with WHO Group 1 PAH diagnosis, step therapy documentation, and REMS enrollment, (2)

How to Get Imbruvica (ibrutinib) Covered by Blue Cross Blue Shield of Texas: Forms, Appeals, and Contact Numbers

Answer Box: Imbruvica (ibrutinib) requires prior authorization from Blue Cross Blue Shield of Texas (BCBSTX). Submit via Availity portal or call the PA number on your member ID card. Include diagnosis confirmation, prior therapy documentation, and medical necessity letter. If denied, you have 60 days to appeal internally, then 4

How to Get Mepsevii (vestronidase alfa-vjbk) Covered by Cigna in Virginia: Timeline, Appeals, and Approval Forms

Quick Answer: Cigna requires prior authorization for Mepsevii (vestronidase alfa-vjbk) in Virginia, typically decided within 72 hours for standard requests and 24 hours for urgent cases. Submit via CoverMyMeds or your EHR's ePA system with complete MPS VII diagnosis documentation and specialist attestation. If denied, you have 180

How to Get Myozyme (Alglucosidase Alfa) Covered by Humana in Ohio: Complete Forms, Appeals & Timeline Guide

Answer Box: Getting Myozyme Covered by Humana in Ohio Humana requires prior authorization for Myozyme (alglucosidase alfa) across all Ohio plans. To get coverage: 1) Have your doctor submit a PA request via Humana's provider portal with confirmed Pompe disease diagnosis (genetic testing + enzyme activity), 2) Include medical

How to Get Upstaza (Kebilidi) Covered by Humana in North Carolina: Timeline, Appeals & Requirements Guide

Answer Box: Getting Upstaza (Kebilidi) Covered by Humana in North Carolina Upstaza (Kebilidi) approval by Humana requires genetic confirmation of AADC deficiency, treatment at a certified center, and prior authorization. Timeline: 1-5 days for initial review, up to 30 days for complex cases. First step today: Contact your neurologist to

How to Get Busulfex (Busulfan Injection) Covered by Aetna CVS Health in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Busulfex Covered by Aetna CVS Health in Texas Busulfex (busulfan injection) requires prior authorization from Aetna CVS Health for bone marrow transplant conditioning in Texas. Submit your PA request through the Availity portal at least 14 days before treatment, including your CML diagnosis (ICD-10: C92.1), prior

How to Get Tysabri (Natalizumab) Covered by Aetna CVS Health in Georgia: Complete Prior Authorization Guide

Answer Box: Getting Tysabri Covered by Aetna CVS Health in Georgia Tysabri (natalizumab) requires prior authorization on all Aetna CVS Health plans in Georgia, with mandatory TOUCH program enrollment before approval. The fastest path: (1) Complete TOUCH enrollment at touchprogram.com for all parties, (2) Submit PA with JCV antibody

The Complete Guide to Getting Zolgensma (Onasemnogene Abeparvovec) Covered by Cigna in New York

Quick Answer: Getting Zolgensma Covered by Cigna in New York Cigna requires prior authorization for Zolgensma (onasemnogene abeparvovec) with strict criteria: genetic confirmation of bi-allelic SMN1 mutations, age under 2 years, recent labs, and anti-AAV9 antibody titer ≤1:50. Submit through Cigna's provider portal or Accredo specialty pharmacy.