Topic

Michigan

A collection of 439 issues

How to Get Amondys 45 (casimersen) Covered by Humana in Michigan: Timeline, Appeals, and Documentation Requirements

Quick Answer: Getting Amondys 45 (casimersen) covered by Humana in Michigan requires prior authorization with genetic testing documentation proving exon 45 skipping mutation, a comprehensive infusion monitoring plan, and baseline lab work. Humana must respond within 14 days (7 days by 2026). If denied, you have 65 days to appeal.

How Long Does It Take to Get Kalydeco (ivacaftor) Approved by UnitedHealthcare in Michigan? Complete Timeline Guide

Quick Answer: UnitedHealthcare Kalydeco Approval Timeline in Michigan Standard timeline: 3-14 days from complete submission. UnitedHealthcare requires prior authorization for Kalydeco (ivacaftor) with CFTR genetic testing documentation. Fastest path: Submit complete OptumRx PA form with mutation test results through provider portal. Start today: Contact your CF specialist to gather genetic

How to Get Myozyme (Alglucosidase Alfa) Covered by Humana in Michigan: Appeals Guide with Forms and Timelines

Answer Box: Getting Myozyme Covered by Humana in Michigan Humana requires prior authorization for Myozyme (alglucosidase alfa) in 2024. If denied, you have clear appeal rights in Michigan with specific timelines: 1. Start with internal appeal to Humana within 60 days of denial 2. Request expedited review if delay would

Work With Your Doctor to Get Takhzyro (lanadelumab-flyo) Approved by Aetna CVS Health in Michigan

Answer Box: Getting Takhzyro Covered in Michigan Aetna CVS Health requires prior authorization for Takhzyro (lanadelumab-flyo) in Michigan. Your fastest path to approval: 1) Work with your doctor to document confirmed HAE diagnosis with lab results (low C4, decreased C1-INH levels), 2) Submit complete prior authorization through Availity portal with

How to Get Tracleer (bosentan) Covered by Cigna in Michigan: Complete Prior Authorization Guide

Answer Box: Getting Tracleer (bosentan) Covered by Cigna in Michigan Cigna requires prior authorization for Tracleer (bosentan) with specific medical criteria: confirmed WHO Group 1 PAH via right heart catheterization, prescriber specialty (cardiology/pulmonology), REMS program enrollment, and step therapy (generic bosentan first). Your fastest path to approval: 1) Ensure

Get Keytruda (Pembrolizumab) Covered by UnitedHealthcare in Michigan: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Keytruda Covered by UnitedHealthcare in Michigan Yes, UnitedHealthcare covers Keytruda (pembrolizumab) but requires prior authorization. Your doctor submits the request through the UnitedHealthcare Provider Portal with your diagnosis, biomarker results (like PD-L1 testing), and prior treatment history. If denied, you have 127 days to file an external

UnitedHealthcare's Coverage Criteria for Upstaza (Eladocagene Exuparvovec) in Michigan: What Counts as "Medically Necessary"?

Answer Box: Getting Upstaza Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Upstaza (eladocagene exuparvovec/Kebilidi) gene therapy with strict medical necessity criteria. To qualify, you need: (1) genetic confirmation of biallelic DDC mutations, (2) documented AADC deficiency symptoms, (3) patient age ≥18 months, and (4) treatment at

Do You Qualify for Pomalyst (pomalidomide) Coverage by Cigna in Michigan? Decision Tree & Next Steps

Answer Box: Quick Qualification Check Most likely to qualify: Patients 18+ with multiple myeloma who've failed both lenalidomide (Revlimid) and a proteasome inhibitor (like bortezomib), with documented progression within 60 days of last therapy. Fastest path: Have your oncologist submit prior authorization through Cigna's provider portal

How to Get Dojolvi (Triheptanoin) Covered by Cigna in Michigan: Appeals Guide and PA Requirements

Answer Box: Getting Dojolvi Covered by Cigna in Michigan Fastest path to approval: Submit prior authorization with molecular confirmation of LC-FAOD, documentation of failed alternative therapies, and specialist letter of medical necessity. If denied, file internal appeal within 180 days, then Michigan DIFS external review within 127 days. Start today:

How to Get Eylea and Lucentis Covered by Aetna CVS Health in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Started To get Eylea or Lucentis covered by Aetna CVS Health in Michigan: First, ensure your ophthalmologist tries bevacizumab (Avastin) unless contraindicated—Aetna requires step therapy. Submit prior authorization with OCT imaging showing retinal thickness ≥300 microns, visual acuity ≤20/40, and documented medical necessity. If denied,