Topic

Insurance Approval

A collection of 5272 issues

How to Get Kineret (anakinra) Covered by Aetna (CVS Health) in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Kineret Covered by Aetna in Georgia Kineret (anakinra) requires prior authorization from Aetna (CVS Health) as a Tier 5 specialty drug. For rheumatoid arthritis, you must document failure of at least one conventional DMARD (like methotrexate) and one preferred biologic. Submit through CVS Specialty Pharmacy or Aetna&

How to Get Breyanzi (Lisocabtagene Maraleucel) Covered by Aetna CVS Health in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Breyanzi Approved by Aetna CVS Health in California Breyanzi (lisocabtagene maraleucel) requires mandatory prior authorization from Aetna CVS Health under their medical benefit, with standard decisions taking 30-45 days. Submit via Availity provider portal or fax to 1-877-269-9916 at least 2 weeks before treatment. If denied, California

How to Get Berinert (C1-Esterase Inhibitor) Covered by Aetna CVS Health in Florida: Complete PA Guide with Forms and Appeals

Answer Box: Fast Track to Berinert Coverage with Aetna CVS Health in Florida Aetna CVS Health requires prior authorization for Berinert (C1-esterase inhibitor) in Florida. Your fastest path: Have your HAE specialist submit a PA request via the Aetna provider portal with confirmed HAE diagnosis, documented Ruconest failure/contraindication, and

How to Get Photrexa (Riboflavin Ophthalmic Solution) Covered by UnitedHealthcare in Michigan: Prior Authorization Timeline & Appeals Guide

Answer Box: Getting Photrexa Covered in Michigan Photrexa (riboflavin ophthalmic solution) requires prior authorization from UnitedHealthcare for corneal cross-linking in progressive keratoconus. The fastest path to approval: (1) Submit PA through the UHC Provider Portal with serial topography showing ≥1 diopter Kmax progression over 12 months, (2) Include pachymetry confirming

Work With Your Doctor to Get Onivyde (Irinotecan Liposome) Approved by UnitedHealthcare in Texas: PA Requirements and Appeal Scripts

Quick Answer: Getting Onivyde Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization through OptumRx for Onivyde (irinotecan liposome) in metastatic pancreatic cancer, with ECOG 0-1 status and adequate organ function documented. Your oncologist must submit clinical notes showing either first-line NALIRIFOX eligibility or gemcitabine failure, with decisions typically within

How to Get Cerezyme (Imiglucerase) Covered by Cigna in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Cerezyme (Imiglucerase) Covered by Cigna in Washington Fastest Path to Approval: Submit Cigna's Cerezyme/Elelyso/VPRIV prior authorization form with documented Gaucher disease (enzyme assay or genetic testing), prescription from a metabolic/lysosomal storage disorder specialist, and clinical notes showing symptoms. No step therapy required.

How to Get Ozempic and Mounjaro Covered by Cigna in North Carolina: Complete Prior Authorization Timeline and Appeal Guide

Answer Box: Getting Ozempic/Mounjaro Covered by Cigna in North Carolina Cigna typically decides prior authorization requests for Ozempic (semaglutide) and Mounjaro (tirzepatide) within 72 hours for standard reviews or 24 hours for urgent cases. For Type 2 diabetes patients in North Carolina, the fastest path to approval requires: (1)

How to Get Arcalyst (Rilonacept) Covered by UnitedHealthcare in Florida: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Arcalyst Approved by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Arcalyst (rilonacept) with 12-month approvals based on FDA indications: CAPS, DIRA, or recurrent pericarditis. Submit PA forms via the provider portal with specialist notes, diagnosis confirmation (ICD-10 codes), and clinical documentation. If denied, you have 180

How to Get Enhertu Covered by Blue Cross Blue Shield in Georgia: Complete Guide to Prior Authorization, Appeals, and Forms

Answer Box: Getting Enhertu Approved in Georgia Blue Cross Blue Shield of Georgia requires prior authorization for Enhertu® (fam-trastuzumab deruxtecan-nxki) with mandatory HER2 testing documentation. Submit your PA request through the Availity provider portal or call member services at the number on your ID card. If denied, you have 180

How to Get Cosentyx (Secukinumab) Covered by Blue Cross Blue Shield in New Jersey: 2025 PA Rules, Appeals, and Step Therapy Overrides

Answer Box: Your Fastest Path to Cosentyx Coverage Getting Cosentyx (secukinumab) approved by Blue Cross Blue Shield in New Jersey requires prior authorization, but New Jersey's 2026 step therapy reform (A1825) strengthens your rights. Submit your PA request through Horizon BCBS's provider portal, documenting inadequate response