Topic

Michigan

A collection of 42 issues

Myths vs. Facts: Getting Koselugo (Selumetinib) Covered by Blue Cross Blue Shield in Michigan - Appeals Guide 2025

Answer Box: Getting Koselugo Covered in Michigan Eligibility: Blue Cross Blue Shield of Michigan covers Koselugo for pediatric patients (ages 2-18) with NF1 and symptomatic, inoperable plexiform neurofibromas requiring prior authorization. Fastest Path: Submit complete PA with baseline LVEF (echocardiogram), ophthalmologic exam, NF1 diagnosis confirmation, and tumor imaging showing inoperability.

How to Get Enbrel (etanercept) Covered by Cigna in Michigan: Complete Prior Authorization Guide

Answer Box: Getting Enbrel Covered by Cigna in Michigan Eligibility: Cigna covers Enbrel (etanercept) for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis with prior authorization. You must be over 18, prescribed by a rheumatologist, and have tried another biologic (excluding etanercept biosimilars). Fastest path: Your doctor submits a

If Ultomiris (Ravulizumab) Isn't Approved by UnitedHealthcare in Michigan: Formulary Alternatives & Exception Strategies

Quick Answer: Your Options When Ultomiris Is Denied If UnitedHealthcare denies Ultomiris (ravulizumab) in Michigan, you have three main paths: try a formulary alternative like Soliris (eculizumab), request a formulary exception with medical necessity documentation, or pursue a formal appeal. Your fastest option is often requesting a peer-to-peer review where

Renewing Fabrazyme (Agalsidase Beta) Approval with UnitedHealthcare in Michigan: 2025 Requirements and Timeline

Answer Box: Renewing Fabrazyme with UnitedHealthcare in Michigan Fabrazyme requires annual reauthorization with UnitedHealthcare, typically 12 months after initial approval. Start the renewal process 30 days before expiration to avoid coverage gaps. Submit updated clinical documentation showing treatment response through your provider's UnitedHealthcare portal or OptumRx system. If

How to Get Acthar Gel Covered by Cigna in Michigan: Prior Authorization, Appeals, and Formulary Alternatives Guide

Answer Box: Getting Acthar Gel Covered by Cigna in Michigan Cigna requires prior authorization and step therapy for Acthar Gel (repository corticotropin injection) in Michigan. You'll need documented failure or contraindication to preferred alternatives like prednisone or IV methylprednisolone. If denied, Michigan gives you 127 days to file

How to Get Elevidys (Delandistrogene Moxeparvovec-Rokl) Covered by Humana in Michigan: Forms, Appeals, and State Protections

Quick Answer: Getting Elevidys Covered by Humana in Michigan Elevidys requires prior authorization from Humana Medicare Advantage plans. Your fastest path: 1) Gather DMD genetic testing, prior steroid therapy records, and functional assessments; 2) Have your prescriber submit a complete PA request with medical necessity documentation; 3) If denied, file

Coding That Helps Get Darzalex/Darzalex Faspro (Daratumumab) Approved by Humana in Michigan: ICD-10, J-Codes & Appeal Guide

Answer Box: Getting Darzalex/Darzalex Faspro Covered by Humana in Michigan Humana requires prior authorization for Darzalex (daratumumab) in 2024. The fastest path to approval: ensure proper ICD-10 coding (C90.00-C90.02 for multiple myeloma, E85.4/E85.9 for AL amyloidosis), use correct HCPCS code J9144 for Faspro billing,

How to Get Adynovate Covered by UnitedHealthcare in Michigan: Prior Authorization, Appeals, and State Protections

Quick Answer: Getting Adynovate Covered by UnitedHealthcare in Michigan Adynovate (bdanocog alfa pegol) requires prior authorization from UnitedHealthcare/OptumRx in Michigan. Submit your PA request through the UnitedHealthcare Provider Portal or call 800-903-5253 for Medicaid plans. If denied, you have strong appeal rights under Michigan's Patient's

How to Get Pomalyst (Pomalidomide) Covered by Humana in Michigan: Prior Authorization Guide & Appeal Templates

Answer Box: Getting Pomalyst (Pomalidomide) Covered by Humana in Michigan Fastest path to approval: Submit prior authorization with documented failure of both lenalidomide and a proteasome inhibitor, plus oncologist letter confirming medical necessity. If denied, file internal appeal within 65 days, then request Michigan DIFS external review within 127 days.

How to Get Dupixent (dupilumab) Covered by Cigna in Michigan: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Started To get Dupixent (dupilumab) covered by Cigna in Michigan, you'll need prior authorization through their specialty pharmacy network. The fastest path: (1) Have your doctor submit a PA request via CoverMyMeds or the Cigna provider portal with complete clinical documentation, (2) Set up specialty