Topic

Insurance Approval

A collection of 980 issues

How to Get Carbaglu (Carglumic Acid) Covered by Humana in Virginia: Complete Appeals Guide

Answer Box: Getting Carbaglu Covered by Humana in Virginia Humana requires prior authorization for Carbaglu (carglumic acid) for NAGS deficiency treatment. In Virginia, you have strong appeal rights through the State Corporation Commission Bureau of Insurance. First steps: 1) Gather genetic confirmation of NAGS deficiency and elevated ammonia labs, 2)

How to Get Joenja (leniolisib) Covered by Aetna (CVS Health) in North Carolina: Complete Guide to Prior Authorization, Appeals, and Cost Assistance

Answer Box: Getting Joenja (leniolisib) Covered by Aetna (CVS Health) in North Carolina Joenja (leniolisib) requires prior authorization from Aetna (CVS Health) with genetic confirmation of APDS, specialist prescriber, and patient meeting age/weight criteria (≥12 years, ≥45 kg). The medication costs $250 per 30-day supply on the specialty tier,

How to Get Uplizna (inebilizumab) Covered by Cigna in Michigan: Medical Necessity Criteria & Appeal Process

Answer Box: Getting Uplizna (inebilizumab) Covered by Cigna in Michigan Cigna requires prior authorization for Uplizna (inebilizumab) with specific medical necessity criteria: You must be 18+ with AQP4-positive NMOSD or IgG4-related disease, prescribed by/with a neurologist, and have completed HBV screening. Fastest path: Complete Cigna's prior authorization

How to Get Ilaris (Canakinumab) Covered by Aetna CVS Health in New Jersey: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Ilaris Covered by Aetna CVS Health in New Jersey Ilaris (canakinumab) requires prior authorization from Aetna CVS Health for all New Jersey members. The fastest path to approval: have your rheumatologist or immunologist complete Aetna's Ilaris precertification form with documentation of your diagnosis (Still'

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