Topic

Michigan

A collection of 415 issues

How to Get Ferriprox (Deferiprone) Covered by Humana in Michigan: Prior Authorization Guide and Appeals Process

Answer Box: Getting Ferriprox (Deferiprone) Covered by Humana in Michigan Fastest path to approval: Submit prior authorization with documented ANC ≥1.5 x 10⁹/L, weekly monitoring plan, and evidence of transfusional iron overload (ferritin >1000 ng/mL). If denied, you have 65 days to appeal internally, then 127

How to Get Mavenclad (Cladribine Tablets) Covered by Cigna in Michigan: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Mavenclad Covered by Cigna in Michigan Cigna requires prior authorization for Mavenclad (cladribine tablets) with strict step therapy requirements - you must have failed two disease-modifying therapies (DMTs) or one high-efficacy agent like Ocrevus or Tysabri. Your neurologist submits the PA via Cigna's provider portal

How to Get Photrexa (Riboflavin Ophthalmic Solution) Covered by UnitedHealthcare in Michigan: Prior Authorization Timeline & Appeals Guide

Answer Box: Getting Photrexa Covered in Michigan Photrexa (riboflavin ophthalmic solution) requires prior authorization from UnitedHealthcare for corneal cross-linking in progressive keratoconus. The fastest path to approval: (1) Submit PA through the UHC Provider Portal with serial topography showing ≥1 diopter Kmax progression over 12 months, (2) Include pachymetry confirming

Myths vs. Facts: Getting Vyondys 53 (golodirsen) Covered by Blue Cross Blue Shield of Michigan – Complete 2025 Guide

Answer Box: Getting Vyondys 53 Covered by Blue Cross Blue Shield of Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Vyondys 53 (golodirsen), with genetic testing confirming DMD mutation amenable to exon 53 skipping from a CLIA-certified lab. Submit via the BCBSM Availity provider portal with complete

Do You Qualify for Evrysdi Coverage by Blue Cross Blue Shield of Michigan? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Evrysdi Coverage Blue Cross Blue Shield of Michigan requires prior authorization for Evrysdi (risdiplam) with specific criteria: confirmed SMA diagnosis via genetic testing, baseline motor function assessment, and specialist involvement. Start today: Download the BCBSM-specific PA form, gather genetic test results and motor function

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,

Oxbryta (Voxelotor) Denied by UnitedHealthcare in Michigan? FDA Withdrawal & Alternative Coverage Options

Answer Box: Oxbryta Coverage Status & Next Steps Oxbryta (voxelotor) is no longer available in the US after Pfizer's voluntary withdrawal in September 2024 due to safety concerns. UnitedHealthcare automatically denies all Oxbryta claims since the drug lost FDA approval. If you're currently taking Oxbryta, work

Renewing Cabometyx (Cabozantinib) Coverage with Humana in Michigan: Complete Timeline and Documentation Guide

Answer Box: Renewing Cabometyx Coverage with Humana in Michigan Humana requires prior authorization renewal for Cabometyx (cabozantinib) before your current approval expires. Submit renewal requests at least 5-7 days early via Humana's provider portal or fax, including updated clinical documentation proving ongoing medical necessity. If denied, you have

How to Get Cometriq (cabozantinib) Covered by Cigna in Michigan: Complete PA and Appeals Guide

Answer Box: Getting Cometriq (cabozantinib) Covered by Cigna in Michigan Cometriq requires prior authorization through Cigna and must be dispensed through Accredo specialty pharmacy. Your oncologist submits clinical documentation proving medullary thyroid carcinoma (MTC) diagnosis with standard review completed within 72 hours. If denied, you have 180 days for internal

If Tagrisso (Osimertinib) Isn't Approved by Blue Cross Blue Shield in Michigan: Formulary Alternatives & Exception Paths

Answer Box: Getting Tagrisso Alternatives or Exceptions with BCBS Michigan If BCBS Michigan denies Tagrisso (osimertinib), you have three main paths: try formulary alternatives like erlotinib or gefitinib with prior authorization, request a formulary exception for Tagrisso with medical necessity documentation, or appeal the denial through Michigan's external