Topic

Michigan

A collection of 444 issues

How to Get Filsuvez (Birch Triterpenes Topical Gel) Covered by Humana in Michigan: Complete Appeals Guide 2025

Answer Box: Getting Filsuvez Covered by Humana in Michigan Filsuvez (birch triterpenes topical gel) requires prior authorization from Humana Medicare Advantage plans. To get coverage in Michigan: (1) Submit a complete prior authorization request with genetic testing confirming dystrophic or junctional epidermolysis bullosa, (2) Document failed treatments including wound care

How to Get Carbaglu (Carglumic Acid) Approved by Blue Cross Blue Shield of Michigan: Timeline, Forms & Appeals Process

Answer Box: Getting Carbaglu Approved in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Carbaglu (carglumic acid) with decisions within 15 days (standard) or 72 hours (expedited). Key requirements: confirmed NAGS deficiency via genetic/enzyme testing, documented hyperammonemia, and metabolic specialist involvement. If denied, you have 127

Getting Pyrukynd (Mitapivat) Covered by UnitedHealthcare in Michigan: Prior Authorization Guide, Appeals Process & Forms

Answer Box: Getting Pyrukynd Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Pyrukynd (mitapivat) in Michigan with strict genetic and clinical criteria. To get approved: (1) Confirm pyruvate kinase deficiency with genetic testing showing at least two PKLR variants (one missense), (2) Have a hematologist or nephrologist submit

Getting Chenodal (Chenodiol) Covered by Cigna in Michigan: PA Forms, Appeals Process & Approval Timeline

Answer Box: Your Path to Chenodal Coverage Chenodal (chenodiol) requires prior authorization from Cigna and is covered on most formularies for radiolucent gallstones in surgical non-candidates. To get approved in Michigan: (1) Ensure your gastroenterologist documents failed ursodiol therapy for 6+ months, (2) Submit Cigna's PA form with

Getting Skyrizi (Risankizumab) Covered by Humana in Michigan: Prior Authorization, Appeals, and Formulary Alternatives

Quick Answer: Getting Skyrizi Covered by Humana in Michigan Fastest path to approval: Skyrizi (risankizumab) requires prior authorization from Humana and typically isn't covered as a first-line therapy. You'll need documented failure of TNF inhibitors like Humira first. First step today: Have your prescriber gather records

Qalsody (Tofersen) Approval with UnitedHealthcare in Michigan: Answers to the Most Common Questions

Answer Box: Getting Qalsody (Tofersen) Covered by UnitedHealthcare in Michigan Yes, UnitedHealthcare covers Qalsody (tofersen) for ALS patients with confirmed SOD1 mutations, but requires prior authorization through OptumRx. Key requirements: SOD1 genetic testing, neurologist prescription, baseline ALSFRS-R score, and no invasive ventilation. If denied, Michigan residents have 127 days to

How to Get Cerezyme (Imiglucerase) Covered by Blue Cross Blue Shield of Michigan: 2024 PA Requirements, Appeals Process & Forms

Answer Box: Getting Cerezyme Covered by Blue Cross Blue Shield of Michigan Good news for Michigan patients: Blue Cross Blue Shield of Michigan (BCBSM) covers Cerezyme as its preferred enzyme replacement therapy for Type 1 Gaucher disease. As of January 1, 2024, no prior authorization is required for Medicare Advantage

Getting Brineura (Cerliponase Alfa) Approved by Humana in Michigan: Complete PA Guide and Appeals Process

Answer Box: Quick Path to Brineura Coverage Brineura (cerliponase alfa) requires prior authorization from Humana for all plans. To get approved in Michigan: (1) Your pediatric neurologist submits PA documentation including CLN2 diagnosis confirmation, Hamburg scale scores, and genetic testing results, (2) Humana reviews within 72 hours for standard requests,

Do You Qualify for Eloctate Coverage by Cigna in Michigan? Decision Tree & Next Steps

Quick Answer: If you have confirmed Hemophilia A and a hematologist willing to prescribe Eloctate, you're likely eligible for Cigna coverage in Michigan. Your doctor must submit prior authorization through Cigna's provider portal or call 800-882-4462. Standard approval takes 15 days; expedited requests get 72-hour decisions.

How to Get Hetlioz (tasimelteon) Covered by Aetna CVS Health in Michigan: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Hetlioz Covered by Aetna CVS Health in Michigan Aetna CVS Health requires prior authorization for Hetlioz (tasimelteon) with strict criteria: total blindness for Non-24-Hour Sleep-Wake Disorder or genetic confirmation for Smith-Magenis Syndrome, failed melatonin trial, and specialist prescribing. If denied, you have 180 days to appeal internally,