Topic

Insurance Approval

A collection of 926 issues

How to Get Elzonris (Tagraxofusp-erzs) Covered by Blue Cross Blue Shield in Georgia: Complete Appeals Guide with Forms and Timelines

Quick Answer: Blue Cross Blue Shield Georgia requires prior authorization for Elzonris (tagraxofusp-erzs) to treat BPDCN in patients ≥2 years old. You'll need confirmed BPDCN diagnosis, serum albumin ≥3.2 g/dL, and a monitoring plan for capillary leak syndrome. Submit through the BCBS provider portal with complete

How to Get Bylvay (odevixibat) Covered by UnitedHealthcare in California: Forms, Timelines & Appeal Scripts

Answer Box: Fastest Path to Bylvay Coverage Bylvay (odevixibat) is covered on UnitedHealthcare's California HMO formulary as Tier 3 with prior authorization required. To get approved: 1) Ensure your gastroenterologist or hepatologist submits PA documentation including genetic PFIC diagnosis (or confirmed Alagille syndrome), moderate-to-severe pruritus, failure of two

How to Get Rylaze Approved by Aetna CVS Health in New Jersey: Timeline, Appeals, and Success Strategies

Answer Box: Getting Rylaze Covered by Aetna CVS Health in New Jersey Rylaze (asparaginase erwinia chrysanthemi recombinant) requires prior authorization from Aetna CVS Health. The fastest path to approval: (1) Document hypersensitivity to E. coli asparaginase with clinical notes showing reaction details, (2) Submit complete PA request via Availity portal

Get Fabrazyme (Agalsidase Beta) Covered by Humana in Virginia: Complete Guide to Prior Authorization, Appeals, and Success Strategies

Quick Answer: To get Fabrazyme (agalsidase beta) covered by Humana in Virginia, you need prior authorization with genetic confirmation of Fabry disease, a specialist prescription, and complete clinical documentation. Submit through Humana's provider portal with HCPCS code J0180. If denied, you have 65 days to appeal, followed by

How to Get Tepezza (teprotumumab) Covered by Humana in Pennsylvania: Prior Authorization Guide and Appeals Process

Answer Box: Getting Tepezza Covered by Humana in Pennsylvania Tepezza (teprotumumab) requires prior authorization from Humana for thyroid eye disease (TED) treatment. To get approved: (1) Your ophthalmologist or endocrinologist must document active, moderate-to-severe TED with Clinical Activity Score ≥3 and proptosis measurements, (2) Submit prior authorization through Humana'

How to Get Ofev (nintedanib) Covered by Aetna CVS Health in California: Prior Authorization Guide and Appeals Process

Answer Box: Getting Ofev (nintedanib) Covered by Aetna CVS Health in California Ofev (nintedanib) is covered by Aetna CVS Health as a Tier 4 specialty drug with strict prior authorization requirements. You'll need HRCT showing ≥10% lung fibrosis, recent PFTs (FVC ≥45% predicted), and evidence of disease progression

How to Get Kuvan (Sapropterin) Covered by Aetna CVS Health in New Jersey: Complete Appeals Guide

Answer Box: Your Fastest Path to Kuvan Coverage Aetna CVS Health requires prior authorization for Kuvan (sapropterin) in New Jersey. Start by having your metabolic specialist submit a PA request through Aetna's Availity portal with complete PKU documentation, baseline phenylalanine levels, and dietary management records. If denied, you

How to Get Signifor LAR (Pasireotide) Covered by Cigna in Pennsylvania: Prior Authorization Requirements and Appeals Process

Quick Answer: Getting Cigna Coverage for Signifor LAR in Pennsylvania Cigna requires prior authorization for Signifor/Signifor LAR (pasireotide) with strict medical necessity criteria. Your endocrinologist must document: confirmed acromegaly or Cushing's disease diagnosis, elevated IGF-1/UFC levels, failed surgery or ineligibility, and trial/failure of first-generation somatostatin

Get Hemlibra (Emicizumab) Covered by Humana in New York: Complete Guide to Prior Authorization and Appeals

Answer Box: Quick Path to Hemlibra Coverage Hemlibra (emicizumab) requires prior authorization from Humana Medicare plans. To get approved in New York: 1) Have your hematologist submit a PA request with hemophilia A diagnosis, FVIII inhibitor test results, and treatment history to Humana at 877-486-2621. 2) If denied, request a

How to Get Breyanzi (lisocabtagene maraleucel) Covered by Cigna in Illinois: Complete Guide to Prior Authorization, Appeals, and State Resources

Answer Box: Getting Breyanzi Covered by Cigna in Illinois Fastest path to approval: Submit your prior authorization through CoverMyMeds or ExpressPAth with complete medical documentation showing refractory large B-cell lymphoma or CLL/SLL with transformation. First step today: Verify your plan covers specialty drugs through Express Scripts/Accredo, then gather