Topic

Michigan

A collection of 42 issues

Getting Evkeeza (Evinacumab-dgnb) Covered by Cigna in Michigan: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Fast Track to Evkeeza Coverage in Michigan To get Evkeeza (evinacumab-dgnb) covered by Cigna in Michigan: Your doctor must submit prior authorization with confirmed HoFH diagnosis (genetic testing or clinical criteria), documentation of failed therapies (statin, ezetimibe, PCSK9 inhibitor), and recent LDL-C levels. Submit through Cigna's

Getting Prolastin-C Covered by Blue Cross Blue Shield of Michigan: PA Requirements, Appeals, and State Protections (2024-2025)

Answer Box: How to Get Prolastin-C Covered by BCBS Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Prolastin-C (alpha1-proteinase inhibitor) for commercial members, with specific criteria including confirmed alpha-1 antitrypsin deficiency, nonsmoker status, and symptomatic emphysema. Medicare Plus Blue and BCN Advantage members don't need

How to Get Rinvoq (upadacitinib) Covered by Blue Cross Blue Shield of Michigan: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Rinvoq Covered in Michigan Rinvoq (upadacitinib) requires prior authorization from Blue Cross Blue Shield of Michigan and is typically covered as a preferred alternative for autoimmune conditions like rheumatoid arthritis and ulcerative colitis. Your fastest path to approval: 1. Confirm formulary status: Rinvoq is covered but requires

How to Get Ofev (nintedanib) Covered by UnitedHealthcare in Michigan: Prior Authorization, Appeals, and State Protections

Answer Box: Quick Path to Ofev Coverage UnitedHealthcare requires prior authorization for Ofev (nintedanib) in Michigan with specific documentation: pulmonologist evaluation, confirmed IPF/ILD diagnosis, HRCT showing fibrosis, and PFT decline evidence. If denied, you have strong appeal rights through Michigan's 127-day external review process via DIFS. Your

Get Arikayce Covered by Blue Cross Blue Shield Michigan: Prior Authorization Forms, Appeals, and State Review Process

Quick Answer: Arikayce requires prior authorization from Blue Cross Blue Shield of Michigan, typically with step therapy requirements. Start by having your doctor submit a PA request with documentation of refractory MAC lung disease and failed standard therapies. If denied, you have 127 days to file an external review with

Work With Your Doctor to Get Onivyde (Irinotecan Liposome) Approved by Aetna CVS Health in Michigan

Quick Answer: Getting Aetna CVS Health to Cover Onivyde in Michigan Aetna (CVS Health) requires prior authorization for Onivyde (irinotecan liposome), but approval is achievable with proper documentation. Your doctor must submit a request at least two weeks before treatment through the Availity provider portal with complete medical records, diagnosis

How to Get Dojolvi (Triheptanoin) Covered by UnitedHealthcare in Michigan: Complete PA Guide with Appeal Scripts

Answer Box: Getting Dojolvi Covered by UnitedHealthcare in Michigan Dojolvi (triheptanoin) requires prior authorization from UnitedHealthcare for long-chain fatty acid oxidation disorders (LC-FAOD). Key requirements: molecular genetic confirmation of LC-FAOD, prescription from a board-certified medical geneticist, no concurrent MCT products, and dosing ≤35% of daily calories. First step: Download the

How to Get Tysabri (Natalizumab) Covered by UnitedHealthcare in Michigan: Appeals, Copay Programs & Prior Authorization

Quick Answer: Getting Tysabri Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Tysabri (natalizumab) through their Provider Portal or by calling 888-397-8129. If denied, you have internal appeal rights followed by Michigan DIFS external review within 127 days. First step today: Have your doctor submit a prior authorization

Getting Hetlioz LQ (Tasimelteon) Covered by Cigna in Michigan: Complete PA Guide and Appeals Process

Answer Box: How to Get Hetlioz LQ Covered by Cigna in Michigan Fastest path to approval: Submit prior authorization with confirmed Smith-Magenis Syndrome genetic testing, documented melatonin failure, and weight-based dosing rationale. If denied, file internal appeal within 180 days, then external review with Michigan DIFS within 127 days. Start

How to Get Rezlidhia (olutasidenib) Covered by Aetna CVS Health in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Rezlidhia Coverage Getting Rezlidhia (olutasidenib) covered by Aetna CVS Health in Michigan requires prior authorization with documented IDH1 mutation, hematology/oncology specialist prescription, and evidence of prior therapy failures. Start by having your oncologist submit a PA request through Aetna's provider portal with