Topic

Michigan

A collection of 504 issues

How to Get Epidiolex (Cannabidiol) Covered by UnitedHealthcare in Michigan: Appeals, Forms & State Protections

Answer Box: Your Path to Epidiolex Coverage in Michigan UnitedHealthcare requires prior authorization for Epidiolex (cannabidiol), with step therapy requirements varying by seizure disorder. For Dravet syndrome or tuberous sclerosis complex (TSC), approval is based on diagnosis alone. For Lennox-Gastaut syndrome (LGS), you'll need documented 8-week trials of

Getting Upstaza (Eladocagene Exuparvovec) Covered by Aetna CVS Health in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Upstaza Coverage To get Upstaza (eladocagene exuparvovec) covered by Aetna CVS Health in Michigan: Submit prior authorization with genetic confirmation of AADC deficiency, FDA approval documentation, and medical necessity letter from a certified neurosurgical center. If denied, file internal appeal within 180 days, then external

How to Get Filspari (sparsentan) Covered by Humana in Michigan: Complete PA Guide and Appeal Process

Answer Box: Your Path to Filspari Coverage To get Filspari (sparsentan) covered by Humana in Michigan: You need biopsy-proven IgA nephropathy with persistent proteinuria ≥1g/day despite ACE inhibitor/ARB therapy, plus enrollment in the FDA REMS program with quarterly liver function tests. Submit prior authorization through your nephrologist using

How to Get Krystexxa (Pegloticase) Covered by Humana in Michigan: Complete PA Forms and Appeals Guide

Answer Box: Getting Krystexxa Covered by Humana in Michigan Krystexxa (pegloticase) requires prior authorization from Humana Medicare Advantage plans in Michigan. Your fastest path to approval: (1) Verify your rheumatologist has documented failure of allopurinol and febuxostat at maximum doses for ≥3 months each, (2) Submit PA request via Humana

Getting Trikafta (Elexacaftor/Tezacaftor/Ivacaftor) Covered by Aetna CVS Health in Michigan: Prior Authorization, Appeals, and Alternative Options

Quick Answer: Getting Trikafta Covered by Aetna CVS Health in Michigan Trikafta requires prior authorization from Aetna CVS Health with CFTR genotype testing (≥1 F508del mutation), cystic fibrosis diagnosis (ICD-10 E84.x), age ≥2 years, and baseline liver function tests. Submit via CVS Caremark Specialty pharmacy with 2+ weeks lead

How to Get Rebif (Interferon Beta-1a) Covered by UnitedHealthcare in Michigan: Complete Timeline and Appeals Guide

Quick Answer: Getting Rebif Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Rebif (interferon beta-1a) in Michigan, typically processed in 24-72 hours for complete submissions. Submit via the UHC Provider Portal with MS diagnosis (ICD-10 G35), recent MRI results, baseline labs (CBC, LFTs), and medical necessity letter. If

How to Get Amondys 45 (Casimersen) Covered by Blue Cross Blue Shield Michigan: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Amondys 45 Covered in Michigan Blue Cross Blue Shield of Michigan (BCBSM) currently considers Amondys 45 (casimersen) investigational/experimental, requiring prior authorization that's typically denied. However, Michigan patients have strong appeal rights through DIFS external review. Fastest path to approval: 1. Submit prior authorization with

How Long Does It Take to Get Jynarque (tolvaptan) Approved by Aetna (CVS Health) in Michigan? Timeline & Appeal Process

Answer Box: Getting Jynarque (tolvaptan) Covered by Aetna (CVS Health) in Michigan Aetna (CVS Health) requires prior authorization for Jynarque (tolvaptan) in Michigan, processed through CVS Specialty Pharmacy. Standard approval takes up to 9 calendar days under Michigan law, with urgent requests decided within 72 hours. The process involves REMS

How to Get Turalio (Pexidartinib) Covered by Blue Cross Blue Shield in Michigan: Complete PA Timeline & Appeal Guide

Answer Box: Getting Turalio Covered by Blue Cross Blue Shield in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Turalio (pexidartinib) to treat TGCT, with approval contingent on REMS enrollment, confirmed diagnosis, and surgical non-feasibility documentation. The fastest path: (1) Enroll all parties in REMS at turaliorems.

How to Get Revlimid (Lenalidomide) Covered by Blue Cross Blue Shield Michigan: Complete Prior Authorization and Appeals Guide 2025

Answer Box: Getting Revlimid Covered by BCBS Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Revlimid (lenalidomide) through their Oncology Value Management program. The fastest path to approval involves three key steps: (1) Ensure REMS compliance documentation is complete, (2) Submit PA request via OncoHealth with complete