Topic

Michigan

A collection of 415 issues

How to Get Qinlock (ripretinib) Covered by Blue Cross Blue Shield of Michigan: Forms, Appeals, and Prior Authorization Guide

Quick Answer: Getting Qinlock Approved by BCBS Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Qinlock (ripretinib), typically after documented failure of at least three prior kinase inhibitors including imatinib. Submit requests through the provider portal or OncoHealth OneUM portal for oncology drugs. If denied, you have

How to Get Adynovate (bdanocog alfa pegol) Covered by Humana in Michigan: Complete Prior Authorization Guide

Answer Box: Getting Adynovate Covered by Humana in Michigan Fastest Path: Humana requires prior authorization for Adynovate (bdanocog alfa pegol) with step therapy requirements. Submit documentation showing hemophilia A diagnosis (ICD-10: D66), factor VIII levels, bleeding history, and any prior factor VIII failures. Use J-code J7207 for billing. First step

Renewing Xospata (Gilteritinib) Approval with Blue Cross Blue Shield Michigan: Complete Timeline and Documentation Guide

Answer Box: Renewing Xospata Coverage in Michigan Most Blue Cross Blue Shield Michigan (BCBSM) Xospata prior authorizations require renewal every 6-12 months. Start the renewal process 14 days before expiration by submitting updated clinical documentation through the BCBSM provider portal. Required documents include: treatment response data, current FLT3 mutation status,

Myths vs. Facts: Getting Emgality (galcanezumab-gnlm) Covered by Aetna (CVS Health) in Michigan

Answer Box: Getting Emgality Covered by Aetna in Michigan Fast Facts: Aetna (CVS Health) requires prior authorization for Emgality (galcanezumab-gnlm) with documented failure of two generic migraine preventives. If denied, you have 180 days for internal appeals, then 127 days for Michigan DIFS external review. First step today: Request your

How to Get Increlex (mecasermin) Covered by Blue Cross Blue Shield of Michigan: Prior Authorization Forms, Appeal Timeline, and State Review Process

Quick Answer: Blue Cross Blue Shield of Michigan requires prior authorization for Increlex (mecasermin) for severe primary IGF-1 deficiency in children ≥2 years old. Your pediatric endocrinologist must document height ≤-3.0 SD, low IGF-1 levels, and normal/elevated growth hormone. If denied, you have 127 days to file an

Getting Qalsody (Tofersen) Covered by Aetna CVS Health in Michigan: ICD-10, HCPCS J-Code, and Billing Guide

Answer Box: Fast Track to Qalsody Coverage Aetna CVS Health requires prior authorization for Qalsody (tofersen) in Michigan using specific coding and documentation requirements. Use ICD-10 code G12.21 for ALS diagnosis, HCPCS J-code J1304 for billing, and NDC 64406-0109-01 for drug identification. Submit complete documentation including SOD1 genetic test

Myths vs. Facts: Getting Elevidys (delandistrogene moxeparvovec-rokl) Covered by Aetna (CVS Health) in Michigan

Answer Box: Getting Elevidys Covered by Aetna (CVS Health) in Michigan Eligibility: Aetna covers Elevidys for ambulatory DMD patients aged 4+ with confirmed genetic mutation, anti-AAVrh74 antibodies <1:400, and treatment at designated centers. Fastest path: Submit prior authorization 2-3 weeks before treatment with genetic testing, antibody results, and

The Requirements Checklist to Get Cometriq (Cabozantinib) Covered by Aetna (CVS Health) in Michigan

Answer Box: Get Cometriq Covered by Aetna CVS Health in Michigan Cometriq (cabozantinib) requires prior authorization from Aetna CVS Health for medullary thyroid carcinoma in Michigan. Submit complete documentation including confirmed MTC diagnosis (ICD-10: C73), prior treatment history, and medical necessity justification via the Aetna provider portal or fax to

How to Get Juxtapid (lomitapide) Covered by Aetna (CVS Health) in Michigan: Complete Guide to Forms, Appeals, and Approval

Answer Box: Get Juxtapid (lomitapide) Covered by Aetna (CVS Health) in Michigan Fast Track to Approval: Aetna (CVS Health) requires prior authorization for Juxtapid (lomitapide) with documented homozygous familial hypercholesterolemia (HoFH), genetic testing, and failed trials of high-intensity statin + ezetimibe + PCSK9 inhibitor. First step today: Have your doctor gather genetic

If Opzelura Isn't Approved by Blue Cross Blue Shield in Michigan: Formulary Alternatives & Exception Paths

Answer Box: Your Options When BCBS Michigan Denies Opzelura If Blue Cross Blue Shield of Michigan denies Opzelura (ruxolitinib cream), you have formulary alternatives and exception paths. Common alternatives include tacrolimus (Protopic), pimecrolimus (Elidel), or crisaborole (Eucrisa), which typically require documented failure of topical steroids first. For exceptions, gather documentation