Topic

Insurance Approval

A collection of 6349 issues

How to Get Vanflyta (Quizartinib) Covered by Cigna in Washington: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Vanflyta (Quizartinib) Covered by Cigna in Washington Cigna requires prior authorization for Vanflyta (quizartinib) in FLT3-ITD-positive AML patients ≥18 years old with confirmed mutation via FDA-approved testing. Submit comprehensive documentation including baseline ECG showing QTc <450ms, REMS enrollment proof, and oncologist's medical necessity letter.

How Long Does It Take to Get Busulfex (Busulfan Injection) Approved by Blue Cross Blue Shield in New Jersey? Timeline & Appeal Process

Answer Box: Getting Busulfex Approved in New Jersey Blue Cross Blue Shield plans in New Jersey require prior authorization for Busulfex (busulfan injection, HCPCS J0594) used in transplant conditioning regimens. Standard approvals take 9-12 calendar days, while urgent requests for transplant conditioning receive decisions within 24-72 hours. Coverage falls under

How to Get Tegsedi (Inotersen) Covered by Humana in Virginia: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Tegsedi (Inotersen) Covered by Humana in Virginia Tegsedi (inotersen) requires prior authorization from Humana Medicare Advantage and Part D plans. The fastest path to approval involves three key steps: (1) Ensure your prescriber enrolls in the FDA's Tegsedi REMS program and submits baseline lab results,

How to Get Tepezza (Teprotumumab) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Aetna CVS Health covers Tepezza for moderate-to-severe thyroid eye disease in Virginia with mandatory prior authorization requiring ophthalmologist evaluation, Clinical Activity Score ≥4, and documented steroid failure. Submit PA through CVS Specialty Pharmacy coordination. If denied, Virginia's Bureau of Insurance offers external review within 120 days

If Opfolda (miglustat) Isn't Approved by Humana in Michigan: Formulary Alternatives & Exception Paths

Answer Box: When Humana Denies Opfolda (miglustat) If Humana denies Opfolda (miglustat) for late-onset Pompe disease in Michigan, standard enzyme replacement therapies like Nexviazyme or Lumizyme serve as formulary alternatives. Request a formulary exception via the "Request for Medicare Prescription Drug Coverage Determination" form (fax 877-486-2621) with medical

Work With Your Doctor to Get Entresto (sacubitril/valsartan) Approved by Cigna in California

Answer Box: Getting Entresto (sacubitril/valsartan) Covered by Cigna in California Cigna requires prior authorization for Entresto with step therapy—you must try generic sacubitril-valsartan first. Your cardiologist needs to document heart failure with reduced ejection fraction (LVEF ≤40%) and prior ACE inhibitor or ARB failure/intolerance. If denied, California&

How to Get Bavencio (Avelumab) Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Bavencio Covered in New Jersey Bavencio (avelumab) requires prior authorization from Blue Cross Blue Shield plans in New Jersey, managed through the Carelon Oncology Program. Submit your PA request with diagnosis confirmation, prior treatment history, and dosing per FDA guidelines. If denied, you have 180 days to

Getting StrataGraft Covered by Humana in Florida: Complete Prior Authorization and Appeals Guide

Quick Answer: Your Path to StrataGraft Coverage StrataGraft requires prior authorization through Humana's Medicare Part B medical benefit (not pharmacy) for deep partial-thickness thermal burns in adults. Submit via Humana's provider portal with burn assessment photos, failed therapy documentation, and surgical rationale within 65 days of

Myths vs. Facts: Getting Strensiq (asfotase alfa) Covered by Humana in New Jersey

Answer Box: Getting Strensiq Covered by Humana in New Jersey Strensiq (asfotase alfa) requires prior authorization from Humana and is typically non-formulary, but coverage is possible for pediatric/juvenile-onset hypophosphatasia with proper documentation. Your prescriber must submit both a prior authorization AND formulary exception request with genetic testing results, low

How to Get Photrexa (Riboflavin) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Photrexa Covered by Blue Cross Blue Shield in Washington Blue Cross Blue Shield plans in Washington (Premera Blue Cross and Regence BlueShield) require prior authorization for Photrexa (riboflavin ophthalmic solution) used in epithelium-off corneal cross-linking for progressive keratoconus. To get approval: (1) Document keratoconus progression with serial