Topic

Michigan

A collection of 444 issues

Cigna's Coverage Criteria for Exondys 51 (Eteplirsen) in Michigan: What Counts as "Medically Necessary"?

Answer Box: Getting Exondys 51 Covered by Cigna in Michigan To get Exondys 51 (eteplirsen) covered by Cigna in Michigan, you need genetic confirmation of a DMD mutation amenable to exon 51 skipping, baseline cardiac and pulmonary function tests, and prior authorization through Accredo Specialty Pharmacy. Your neurologist must submit

How to Get Prolastin-C Covered by Humana in Michigan: Prior Authorization Requirements and Appeal Process

Answer Box: Getting Prolastin-C Covered by Humana in Michigan Prolastin-C requires prior authorization from Humana and is subject to step therapy requirements. You'll likely need to try a preferred alpha1-proteinase inhibitor first (like Zemaira) before Humana approves Prolastin-C. Key requirements: confirmed Pi*ZZ genotype, FEV1 ≤65% predicted, and

Getting Rapivab (Peramivir) Covered by Cigna in Michigan: Prior Authorization Forms, Appeals Timeline, and Approval Checklist

Answer Box: Fastest Path to Approval Rapivab (peramivir) requires prior authorization from Cigna for coverage in Michigan. The fastest approval path: (1) Submit PA request within 48 hours of flu symptom onset with documented medical necessity, (2) Include evidence why oral antivirals (Tamiflu) can't be used, and (3)

How to Get Haegarda Approved by Aetna CVS Health in Michigan: Complete Prior Authorization Guide

Quick Answer: Getting Haegarda Approved by Aetna CVS Health in Michigan To get Haegarda (C1-esterase inhibitor, SC) covered by Aetna CVS Health in Michigan, you need: confirmed HAE diagnosis with lab evidence (ICD-10 code D84.1), age ≥6 years, specialist involvement, and comprehensive prior authorization documentation. Submit via Aetna'

Get HyperHEP Covered by Cigna in Michigan: Appeals Guide and Medical Necessity Templates

Answer Box: Getting HyperHEP Covered by Cigna in Michigan HyperHEP (hepatitis B immune globulin) requires prior authorization from Cigna for post-exposure prophylaxis. To get covered: (1) Your doctor submits a formulary exception request with exposure documentation and CDC guideline references within 24-48 hours of exposure, (2) If denied, file an

How to Get Takhzyro (lanadelumab-flyo) Covered by Humana in Michigan: Prior Authorization, Appeals, and Cost Savings

Answer Box: Getting Takhzyro Covered by Humana in Michigan Takhzyro (lanadelumab-flyo) requires prior authorization from Humana in Michigan. Start by having your HAE specialist submit documentation of confirmed hereditary angioedema diagnosis (C4 <14 mg/dL, C1-INH functional activity <50%), attack logs, and medical necessity justification. If denied, you

How to Get Tavalisse (Fostamatinib) Covered by Blue Cross Blue Shield Michigan: Complete Prior Authorization & Appeals Guide

Quick Answer: Getting Tavalisse Covered by BCBS Michigan Tavalisse (fostamatinib) requires prior authorization from Blue Cross Blue Shield of Michigan for chronic immune thrombocytopenia (ITP). The fastest path to approval: ensure your hematologist documents failed prior therapies (corticosteroids, IVIG, or thrombopoietin receptor agonists), submit current platelet count labs (<30,

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

Answer Box: Getting Bavencio (avelumab) Covered by Cigna in Michigan Bavencio (avelumab) requires prior authorization from Cigna and is placed on Tier 5 (specialty) with high cost-sharing. To get coverage in Michigan: 1. Submit Cigna's prior authorization form with diagnosis confirmation (metastatic Merkel cell carcinoma or maintenance urothelial

How to Get Vimizim (Elosulfase Alfa) Covered by Blue Cross Blue Shield of Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Vimizim Covered by Blue Cross Blue Shield of Michigan Prior authorization is required for Vimizim (elosulfase alfa) coverage under all Blue Cross Blue Shield of Michigan (BCBSM) plans. The fastest path to approval involves submitting complete diagnostic documentation (confirmed MPS IVA diagnosis with GALNS enzyme testing), baseline

Getting Kalydeco (Ivacaftor) Covered by Cigna in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Kalydeco (Ivacaftor) Covered by Cigna in Michigan Eligibility: Patients with cystic fibrosis and documented FDA-approved CFTR mutations responsive to ivacaftor can get Kalydeco covered by Cigna with proper documentation. Fastest Path: 1) Gather CFTR genotype test results and CF diagnosis documentation, 2) Have your CF specialist submit