Topic

Michigan

A collection of 417 issues

Get Skyrizi (Risankizumab) Covered by Cigna in Michigan: Complete Prior Authorization and Appeals Guide

Quick Answer: Skyrizi (risankizumab) requires prior authorization from Cigna in Michigan, typically with step therapy requiring TNF inhibitor failure. Submit PA electronically via CoverMyMeds or call 1-800-882-4462. If denied, file internal appeal within 180 days, then external review with Michigan DIFS within 127 days. Your prescriber must document disease severity

Getting Alprolix Covered by Cigna in Michigan: Prior Authorization, Appeals, and Formulary Alternatives Guide

Answer Box: Getting Alprolix Covered by Cigna in Michigan Alprolix (coagulation factor IX, rFIXFc) is typically excluded from Cigna's Express Scripts formulary in 2024, requiring prior authorization and often step therapy with preferred alternatives like Rebinyn, Rixubis, or BeneFIX. Your fastest path to coverage: 1) Have your hematologist

How to Get Idelvion Approved by Aetna CVS Health in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Idelvion Covered by Aetna CVS Health in Michigan Yes, Idelvion (albutrepenonacog alfa) can be covered by Aetna CVS Health in Michigan with proper prior authorization. The fastest path to approval requires: (1) a hematologist's prescription with hemophilia B diagnosis (ICD-10: D67), (2) factor IX activity

How to Get Rinvoq (Upadacitinib) Covered by UnitedHealthcare in Michigan: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Rinvoq Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Rinvoq (upadacitinib) with mandatory step therapy—you must first try and fail at least one TNF inhibitor biologic. To get approval: (1) Your doctor documents your qualifying diagnosis and failed TNF inhibitor trial, (2) Complete required

How to Get Oxlumo (Lumasiran) Covered by Cigna in Michigan: Complete Prior Authorization and Appeals Guide

Quick Answer: To get Oxlumo (lumasiran) covered by Cigna in Michigan, you'll need prior authorization with confirmed PH1 diagnosis, genetic testing (AGXT), nephrologist prescription, and documented urinary oxalate levels. Submit via CoverMyMeds or Cigna portal. If denied, use Michigan's 180-day internal appeal window, then DIFS external

Work With Your Doctor to Get Somatuline Depot (Lanreotide) Approved by Blue Cross Blue Shield in Michigan: Forms, Appeals, and Success Strategies

Answer Box: Getting Somatuline Depot Covered in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Somatuline Depot (lanreotide). Approval depends on FDA-approved diagnosis (acromegaly, neuroendocrine tumors, carcinoid syndrome), documented failure of octreotide, and complete clinical documentation. First step: Have your endocrinologist or oncologist gather your treatment history

How to Get Xospata (gilteritinib) Covered by UnitedHealthcare in Michigan: Forms, Appeals & Step-by-Step Guide

Answer Box: Getting Xospata Approved by UnitedHealthcare in Michigan Xospata (gilteritinib) requires prior authorization through OptumRx for UnitedHealthcare members in Michigan. Your oncologist must submit clinical documentation proving FLT3-mutated relapsed/refractory AML diagnosis, prior therapy history, and medical necessity via the UnitedHealthcare Provider Portal or by calling 1-800-711-4555. If denied,

How to Get Trikafta Covered by Blue Cross Blue Shield of Michigan: Prior Authorization Forms, Appeals, and Approval Timeline

Answer Box: Getting Trikafta Covered by BCBS Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Trikafta (elexacaftor/tezacaftor/ivacaftor), a specialty-tier medication for cystic fibrosis. Key requirements: CFTR genotype documentation, CF specialist prescription, and submission through Walgreens Specialty Pharmacy or Accredo. First step today: Have your CF

How to Get Jynarque (Tolvaptan) Covered by Cigna in Michigan: Complete PA Guide with Forms and Appeal Scripts

Answer Box: Getting Jynarque Covered by Cigna in Michigan Jynarque (tolvaptan) requires prior authorization through Cigna and is typically covered as a Tier 4 specialty medication with step therapy requirements. To get approved in Michigan: 1. Document rapid ADPKD progression (Mayo Class 1C-1E or eGFR decline ≥3 mL/min/1.

How to Get Gilenya (Fingolimod) Covered by Blue Cross Blue Shield of Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Gilenya Covered in Michigan Blue Cross Blue Shield of Michigan (BCBSM) requires prior authorization for Gilenya (fingolimod), typically with step therapy requirements. Your fastest path to approval: (1) Document failed first-line MS therapies like interferon beta or Copaxone, (2) Submit PA via CoverMyMeds with complete EKG monitoring