Topic

Insurance Approval

A collection of 5273 issues

How to Get Nucala (mepolizumab) Covered by Blue Cross Blue Shield in Ohio: Complete PA Guide with Appeals

Answer Box: Quick Path to Nucala Coverage in Ohio To get Nucala (mepolizumab) covered by Blue Cross Blue Shield in Ohio: Submit prior authorization with blood eosinophil count ≥150-300 cells/μL, documentation of severe eosinophilic asthma uncontrolled on high-dose inhaled therapy, and specialist prescription. If denied, file internal appeal within

Getting Somatuline Depot (Lanreotide) Covered by UnitedHealthcare in California: Complete Prior Authorization and Billing Guide

Answer Box: Your Path to Coverage Getting Somatuline Depot (lanreotide) covered by UnitedHealthcare in California requires prior authorization through OptumRx. Start with proper medical coding: ICD-10 E22.0 for acromegaly or appropriate NET codes, HCPCS J1930 (1 mg per unit), and correct NDCs. UnitedHealthcare often requires step therapy with octreotide

How to Get Ibrance (Palbociclib) Covered by Aetna (CVS Health) in Washington: Prior Authorization, Appeals, and Formulary Alternatives Guide

Answer Box: Getting Ibrance (Palbociclib) Approved by Aetna (CVS Health) in Washington Ibrance (palbociclib) requires prior authorization from Aetna (CVS Health) for HR+/HER2- metastatic breast cancer. Submit PA via provider portal or fax with pathology confirming HR+/HER2- status, prior endocrine therapy documentation, and prescriber attestation. Standard decisions take

How to Get Vitrakvi (Larotrectinib) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Vitrakvi Coverage To get Vitrakvi (larotrectinib) covered by UnitedHealthcare in North Carolina: Submit prior authorization via OptumRx with validated NTRK gene fusion test results, oncologist medical necessity letter documenting metastatic/unresectable disease, and prior therapy history. If denied, file internal appeal within 180 days, then

How to Get Trikafta Covered by Aetna CVS Health in Texas: Complete Prior Authorization and Appeals Guide 2025

Quick Answer: Getting Trikafta Approved by Aetna CVS Health in Texas Trikafta requires prior authorization through CVS Caremark specialty pharmacy with CFTR genetic testing, CF specialist prescription, and age ≥2 years. Submit PA via Aetna provider portal with mutation documentation (F508del or responsive variants), baseline labs, and medical necessity letter.

Getting Jakafi (Ruxolitinib) Covered by Humana in Ohio: Prior Authorization, Appeals, and Alternative Options

Answer Box: Fastest Path to Jakafi (Ruxolitinib) Coverage Humana covers Jakafi (ruxolitinib) on Tier 5 specialty with mandatory prior authorization for myelofibrosis and polycythemia vera. Your hematologist submits PA documentation including diagnosis confirmation, prior therapy failures (especially hydroxyurea for PV), recent labs, and specialist notes. Standard approval takes 72 hours;

How to Get Amondys 45 (Casimersen) Covered by Cigna in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Amondys 45 Covered by Cigna in Ohio Cigna requires prior authorization for Amondys 45 (casimersen) with strict eligibility criteria: genetic confirmation of exon 45-amenable DMD mutation, age under 14 at start, 6-minute walk test ≥300 meters, and specialist prescription. Submit through CoverMyMeds or Cigna provider portal with

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

Quick Answer: Getting Soliris Covered by Aetna CVS Health in Georgia Aetna CVS Health requires prior authorization for Soliris (eculizumab) with diagnosis-specific criteria, mandatory meningococcal vaccination ≥2 weeks before treatment, and CVS Specialty Pharmacy dispensing. Submit the Soliris Precertification Form (GR-68742) via Availity portal or fax 1-844-268-7263. If denied, Georgia

Work With Your Doctor to Get Cystadane (Betaine Anhydrous) Approved by Cigna in California: Complete Provider Collaboration Guide

Quick Answer: Getting Cystadane (Betaine Anhydrous) Covered by Cigna in California Cystadane (betaine anhydrous) requires Cigna prior authorization with genetic confirmation, elevated homocysteine levels, and vitamin co-therapy documentation. Your physician must submit medical necessity evidence through Cigna's provider portal within 72 hours (24 hours expedited). If denied, California&

The Requirements Checklist to Get Brensocatib (BRINSUPRI) Covered by Cigna in Michigan

Answer Box: Getting Started in Michigan Cigna requires prior authorization for Brensocatib (BRINSUPRI) with step therapy through macrolide antibiotics. Your pulmonologist submits via CoverMyMeds or fax (866-873-8279) with CT scan confirming bronchiectasis, documented exacerbations (≥2/year for adults), and failed macrolide trials. Standard approval takes 5-10 business days. If denied,