Topic

Michigan

A collection of 42 issues

How to Get Uplizna (inebilizumab) Covered by Cigna in Michigan: Medical Necessity Criteria & Appeal Process

Answer Box: Getting Uplizna (inebilizumab) Covered by Cigna in Michigan Cigna requires prior authorization for Uplizna (inebilizumab) with specific medical necessity criteria: You must be 18+ with AQP4-positive NMOSD or IgG4-related disease, prescribed by/with a neurologist, and have completed HBV screening. Fastest path: Complete Cigna's prior authorization

How to Get Signifor LAR (Pasireotide) Covered by Aetna in Michigan: Prior Authorization Forms and Appeal Guide

Answer Box: Getting Signifor LAR Covered by Aetna in Michigan Aetna requires prior authorization for Signifor LAR (pasireotide) in Michigan. You must document trial and failure of Somatuline Depot (lanreotide) first, plus provide biochemical evidence (elevated UFC for Cushing's disease or IGF-1 for acromegaly). Submit via CVS Specialty

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

Answer Box: Getting Jynarque Covered by UnitedHealthcare in Michigan Quick Path to Approval: UnitedHealthcare requires prior authorization for Jynarque (tolvaptan) with documented ADPKD diagnosis and rapid progression evidence. First step today: Ensure your prescriber and you are enrolled in the mandatory REMS program, then gather 4+ years of eGFR decline

Renewing Fintepla (Fenfluramine) Coverage with Aetna CVS Health in Michigan: Documentation Guide and Timeline

Answer Box: Fintepla (fenfluramine) renewal with Aetna CVS Health in Michigan requires documented seizure frequency reduction, current echocardiogram results, and REMS compliance. Start renewal process 60 days before current authorization expires. Submit seizure logs, cardiac monitoring results, and prescriber attestation through Aetna's provider portal or CVS Caremark. Most

How to Get Adynovate (Antihemophilic Factor VIII) Covered by Aetna CVS Health in Michigan: Prior Authorization Forms, Appeals, and Documentation Requirements

Answer Box: Getting Adynovate Covered by Aetna CVS Health in Michigan To get Adynovate (bdanocog alfa pegol) covered by Aetna CVS Health in Michigan: 1. Submit prior authorization via CVS Caremark specialty fax at 1-888-267-3277 or call 1-855-240-0535 2. Document medical necessity including hemophilia A severity (ICD-10: D66) and why

Myths vs. Facts: Getting Turalio (pexidartinib) Covered by Humana in Michigan

Answer Box: Getting Turalio Covered by Humana in Michigan Yes, Humana covers Turalio (pexidartinib) for TGCT in Michigan, but prior authorization is required. The fastest path to approval: (1) Ensure your prescriber is REMS-certified and submits complete PA documentation including MRI confirming symptomatic TGCT not amenable to surgery, (2) Document

Work With Your Doctor to Get Soliris (Eculizumab) Covered by Cigna in Michigan: Appeal Forms and Clinical Evidence Guide

Quick Answer: Getting Soliris (Eculizumab) Covered by Cigna in Michigan Eligibility: Soliris requires prior authorization through Cigna's specialty pharmacy (Accredo/Express Scripts) for FDA-approved conditions: PNH, atypical HUS, generalized myasthenia gravis, and NMOSD. Key requirements: meningococcal vaccination ≥2 weeks before treatment, confirmed diagnosis with specific lab tests, and

How to Get Kesimpta (Ofatumumab) Covered by Cigna in Michigan: Forms, Appeals, and Approval Scripts

Answer Box: Getting Kesimpta Covered by Cigna in Michigan Kesimpta (ofatumumab) is on Cigna's formulary but requires prior authorization and may need step therapy. To get approved: 1) Have your neurologist submit a PA request with MS diagnosis, prior therapy failures, and clinical notes to Cigna/Express Scripts,

Get Eloctate Covered by Humana in Michigan: Prior Authorization Forms, Appeal Process & Medical Necessity Letters

Quick Answer: Eloctate requires prior authorization from Humana in Michigan. Your hematologist must submit a PA request with clinical documentation showing medical necessity. If denied, you have 65 days to appeal internally, then 127 days for Michigan DIFS external review. Start by gathering your diagnosis, bleeding history, and prior treatment

Get Revlimid (lenalidomide) Covered by UnitedHealthcare in Michigan: Complete Guide to Forms, Appeals & Approval

Answer Box: Quick Path to Approval To get Revlimid (lenalidomide) covered by UnitedHealthcare in Michigan: 1) Verify your plan requires prior authorization through OptumRx, 2) Submit the PA form with diagnosis documentation (multiple myeloma or MDS with 5q deletion qualify automatically), and 3) Ensure REMS program compliance before dispensing. If