Topic

Kalydeco (ivacaftor)

A collection of 32 issues

Renewing Approval for Kalydeco (Ivacaftor) with Blue Cross Blue Shield in California: What to Prepare & When

Answer Box: Kalydeco Renewal Essentials Renew your Kalydeco (ivacaftor) authorization with Blue Cross Blue Shield of California 2-4 weeks before expiration. Submit via AuthAccel portal with updated clinic notes, liver function tests, FEV₁ data, and adherence documentation. Most renewals require proof of ongoing benefit (stable/improved lung function, reduced exacerbations)
6 min read

How to Get Kalydeco (ivacaftor) Covered by UnitedHealthcare in Washington: Complete Prior Authorization Guide with Appeals

Answer Box: Getting Kalydeco Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Kalydeco (ivacaftor) based on confirmed cystic fibrosis diagnosis and FDA-approved CFTR mutations (like G551D, R117H) without step therapy requirements. Submit via the UnitedHealthcare Provider Portal with genetic test results, CF specialist documentation, and baseline liver function
6 min read

The Requirements Checklist to Get Kalydeco (ivacaftor) Covered by UnitedHealthcare in Pennsylvania: Complete PA Guide with Forms and Appeals

Answer Box: Fast Track to Kalydeco Coverage To get Kalydeco (ivacaftor) covered by UnitedHealthcare in Pennsylvania: Submit prior authorization through OptumRx with confirmed cystic fibrosis diagnosis, FDA-cleared CFTR genetic test showing responsive mutation (like G551D or R117H), and CF specialist documentation. If denied, use Pennsylvania's Independent External Review—
5 min read

How to Get Kalydeco (ivacaftor) Covered by Blue Cross Blue Shield in Georgia: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Kalydeco Covered by Blue Cross Blue Shield in Georgia Blue Cross Blue Shield (Anthem) in Georgia covers Kalydeco (ivacaftor) for cystic fibrosis patients with FDA-approved responsive CFTR mutations, but requires prior authorization through their specialty pharmacy network. The fastest path: Have your CF specialist submit a prior
6 min read

How to Get Kalydeco (Ivacaftor) Covered by Cigna in Florida: Complete Coding, Prior Authorization & Appeals Guide

Quick Answer: Kalydeco requires prior authorization from Cigna with documented CFTR mutation testing (G551D, R117H, or other responsive mutations) and ICD-10 code E84.0-E84.9. Your CF specialist must submit genetic testing results, medical necessity documentation, and complete prior authorization within 72 hours for standard review. If denied, Florida residents
6 min read

How to Get Kalydeco (ivacaftor) Covered by UnitedHealthcare in Georgia: Complete Coding, Prior Authorization & Appeals Guide

Answer Box: Getting Kalydeco Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Kalydeco (ivacaftor) in Georgia, but no step therapy is required for patients with ivacaftor-responsive CFTR mutations. Approval depends on proper coding and complete genetic documentation. Three steps to approval: 1. Submit genetic test results showing FDA-approved
5 min read

How to Get Kalydeco (ivacaftor) Covered by UnitedHealthcare in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Kalydeco Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Kalydeco (ivacaftor) as a Tier 5 specialty medication. The fastest path to approval involves three steps: 1) Submit genetic testing confirming an FDA-approved ivacaftor-responsive CFTR mutation, 2) Provide clinical documentation from a CF specialist confirming cystic
6 min read