Topic

Insurance Approval

A collection of 1141 issues

How to Get Tavalisse (Fostamatinib) Covered by Cigna in North Carolina: Prior Authorization Guide with Appeals Process

Quick Answer: Getting Tavalisse Covered by Cigna in North Carolina Tavalisse (fostamatinib) requires prior authorization from Cigna for chronic ITP treatment. You'll need documented failure of at least one prior therapy (steroids, IVIG, or TPO receptor agonists), hematologist involvement, and baseline labs. The fastest path: have your hematologist

How to Get Carbaglu (Carglumic Acid) Covered by Aetna CVS Health in Virginia: Appeals Guide and Templates

Answer Box: Fast Track to Carbaglu Coverage Carbaglu (carglumic acid) is covered by Aetna CVS Health in Virginia for FDA-approved NAGS deficiency with prior authorization. To get approved: 1. Submit PA request with genetic/biochemical confirmation of NAGS deficiency plus elevated plasma ammonia labs 2. If denied, file internal appeal

Get Revcovi (Elapegademase) Covered by Blue Cross Blue Shield Illinois: Complete Guide with Forms and Appeal Steps

Answer Box: Quick Path to Revcovi Coverage Revcovi (elapegademase) is covered by Blue Cross Blue Shield of Illinois but requires specialty pharmacy dispensing and likely prior authorization. To qualify: you need confirmed ADA-SCID diagnosis (enzyme activity <1% normal or genetic testing), prescription from an immunology specialist, and documentation of

How to Get Oxervate (Cenegermin) Covered by Cigna in Ohio: Complete Approval Guide

Answer Box: Getting Oxervate Covered by Cigna in Ohio Oxervate (cenegermin) requires prior authorization from Cigna for stage 2 or 3 neurotrophic keratitis. The fastest path to approval: (1) Have your ophthalmologist document failed conventional treatments and confirm your NK stage, (2) Submit the PA request through Cigna's

How to Get Revlimid (lenalidomide) Covered by Humana in Florida: Complete Approval Guide

Answer Box: Getting Revlimid (lenalidomide) Covered by Humana in Florida Humana requires prior authorization for lenalidomide (generic Revlimid) in Florida Medicare Advantage plans. The fastest path to approval: (1) Ensure your prescriber is REMS-certified, (2) Submit Humana's PA form with complete clinical documentation including diagnosis, prior therapies, and

Do You Qualify for Prolastin-C Coverage by UnitedHealthcare in Georgia? Decision Tree & Next Steps

Answer Box: Your Path to Prolastin-C Coverage in Georgia Yes, you can get Prolastin-C covered by UnitedHealthcare in Georgia if you meet medical necessity criteria. You'll need confirmed alpha1-antitrypsin deficiency with Pi*ZZ genotype, documented emphysema, and AAT levels below 11 µM. Start by having your doctor submit

How to Get Epidiolex (Cannabidiol) Covered by Blue Cross Blue Shield in New York: Complete Decision Tree & Appeal Guide

Answer Box: Your Path to Epidiolex Coverage Epidiolex requires prior authorization from Blue Cross Blue Shield New York plans in 2024. You'll likely qualify if you have a confirmed diagnosis of Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex, plus documented failure of standard anti-seizure medications. First step

Getting Dojolvi (Triheptanoin) Covered by Aetna CVS Health in New York: Complete Guide to Approval, Appeals & Forms

Answer Box: Quick Path to Coverage Dojolvi (triheptanoin) is not on Aetna's 2024 formulary, requiring a formulary exception or prior authorization based on medical necessity. In New York, you have strong appeal rights through the state's external review system if initially denied. Fastest approval path: 1.

Get Advate (octocog alfa) Covered by Aetna CVS Health in Pennsylvania: Complete Guide with Forms and Appeal Process

Answer Box: Getting Advate Covered by Aetna CVS Health in Pennsylvania Yes, Advate (octocog alfa) is covered by Aetna CVS Health in Pennsylvania, but requires prior authorization. Aetna prefers Kovaltry for routine prophylaxis, so you'll need to document failure or intolerance to Kovaltry first. Your hematologist must submit

How to Get Evkeeza (evinacumab-dgnb) Approved by Cigna in Texas: Timeline, Forms & Appeal Process

Quick Answer: Getting Evkeeza Approved by Cigna in Texas Cigna requires prior authorization for Evkeeza (evinacumab-dgnb) to treat homozygous familial hypercholesterolemia (HoFH). Timeline: 7 days for standard review, 72 hours for urgent cases (effective 2026). First step: Gather HoFH diagnosis confirmation, prior therapy records, and recent LDL-C levels. Submit through