Topic

Michigan

A collection of 503 issues

Work With Your Doctor to Get Elelyso (Taliglucerase Alfa) Approved by Aetna CVS Health in Michigan: Complete Provider Collaboration Guide

Answer Box: Getting Elelyso Covered by Aetna CVS Health in Michigan Elelyso (taliglucerase alfa) requires prior authorization from Aetna CVS Health for Type 1 Gaucher disease patients. Success depends on strong provider collaboration: confirmed diagnosis via enzyme/genetic testing, documented failure of preferred ERTs (Cerezyme/VPRIV), and specialist prescriber support.

Cigna's Coverage Criteria for Pombiliti (cipaglucosidase alfa-atga) in Michigan: What Counts as "Medically Necessary"?

Answer Box: Getting Pombiliti Covered by Cigna in Michigan Cigna requires prior authorization for Pombiliti + Opfolda combination therapy for late-onset Pompe disease patients ≥18 years, weighing >40 kg, who show no improvement in forced vital capacity (FVC) or 6-minute walk test after ≥1 year on Lumizyme or Nexviazyme. Submit

How to Get Ofev (nintedanib) Covered by Cigna in Michigan: ICD-10 Codes, Prior Authorization, and Appeal Scripts

Answer Box To get Ofev (nintedanib) covered by Cigna in Michigan: Your pulmonologist must submit prior authorization using Michigan's standardized PA form (FIS 2288) with ICD-10 code J84.112 (IPF) or M34.81 (SSc-ILD), HRCT confirming fibrosis, and PFTs showing FVC ≥40% predicted. Cigna has 15 days to

How to Get Opfolda (miglustat) Covered by Cigna in Michigan: Complete PA Guide and Appeal Process

Answer Box: Getting Opfolda (miglustat) Covered by Cigna in Michigan Eligibility: Adults ≥18 years, >40 kg with late-onset Pompe disease who haven't improved after ≥1 year on Lumizyme or Nexviazyme. Must be prescribed with Pombiliti (combination therapy only). Fastest approval path: 1) Submit prior authorization via CoverMyMeds

How to Get Zolgensma Covered by Cigna in Michigan: Complete Prior Authorization and Appeal Guide (2024)

Answer Box: Getting Zolgensma Covered by Cigna in Michigan Cigna covers Zolgensma (onasemnogene abeparvovec) for spinal muscular atrophy (SMA) in Michigan with prior authorization requiring genetic confirmation of bi-allelic SMN1 mutations, age under 2 years, anti-AAV9 titer ≤1:50, and recent labs (creatinine <1.0 mg/dL, hemoglobin 8-18

Myths vs. Facts: Getting Rinvoq (upadacitinib) Covered by Cigna in Michigan

Answer Box: Getting Rinvoq Covered by Cigna in Michigan Myth: A doctor's prescription guarantees Rinvoq coverage. Fact: Cigna requires prior authorization with documented failure of at least one TNF inhibitor for 3 months. In Michigan, you have 127 days to file an external review with DIFS after final

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 Nucala (Mepolizumab) Approved by Humana in Michigan: Complete Provider Collaboration Guide

Answer Box: Getting Nucala Covered by Humana in Michigan Humana requires prior authorization for Nucala (mepolizumab) with specific criteria: blood eosinophils ≥150 cells/μL, severe asthma despite high-dose ICS/LABA therapy, and ≥2 exacerbations requiring systemic steroids annually. Your pulmonologist or allergist must submit documentation via Humana's provider

How to Get Bylvay (Odevixibat) Covered by Humana in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Bylvay (Odevixibat) Covered by Humana in Michigan Humana requires prior authorization for Bylvay (odevixibat) to treat pruritus in PFIC (≥3 months) or Alagille syndrome (≥12 months). Submit PA via Humana's provider portal with specialist documentation, diagnosis confirmation, pruritus severity scores, and prior treatment failures. If

How to Get Revlimid (Lenalidomide) Covered by Humana in Michigan: Complete Prior Authorization Guide

Quick Answer: Getting Revlimid (Lenalidomide) Covered by Humana in Michigan Humana covers generic lenalidomide (not brand Revlimid) with prior authorization for multiple myeloma, MDS, and other FDA-approved conditions. Your prescriber must be REMS-certified and submit clinical documentation via Humana's provider portal or fax (877-486-2621). Standard approval takes 7