Topic

Michigan

A collection of 444 issues

How to Get Eylea and Lucentis Covered by Cigna in Michigan: Complete PA Guide and Appeals Process

Answer Box: Fast Track to Cigna Approval in Michigan Getting Eylea or Lucentis covered by Cigna requires prior authorization with specific documentation. Your ophthalmologist must submit clinical notes showing wet AMD or diabetic macular edema with OCT imaging, visual acuity measurements, and evidence that lower-cost alternatives like Avastin aren'

How to Get Alecensa (alectinib) Covered by Aetna CVS Health in Michigan: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Alecensa (alectinib) Covered by Aetna CVS Health in Michigan Aetna CVS Health requires prior authorization for Alecensa (alectinib), an ALK inhibitor for non-small cell lung cancer. Your fastest path to approval: Submit the PA request with ALK-positive test results, prior therapy documentation, and medical necessity letter through

Getting Joenja (Leniolisib) Covered by Cigna in Michigan: Prior Authorization Guide and Appeals Process

Answer Box: Quick Path to Approval Joenja (leniolisib) requires Cigna prior authorization in Michigan with specific genetic testing requirements. Your fastest path: (1) Confirm you meet age (≥12 years), weight (≥45 kg), and have genetic confirmation of PIK3CD/PIK3R1 mutations causing APDS, (2) Have your immunologist or specialist submit the

Get Tavneos (Avacopan) Approved by Cigna in Michigan: Forms, Appeals & Contact Guide

Answer Box: Getting Started Cigna covers Tavneos (avacopan) in Michigan with prior authorization for severe ANCA-associated vasculitis (GPA/MPA) when used with standard therapy. Your prescriber must submit clinical documentation through CoverMyMeds or fax to 1-866-873-8279. If denied, internal appeals must be filed within 180 days, followed by Michigan DIFS

Renewing Brineura (Cerliponase Alfa) Coverage with Aetna in Michigan: Timeline, Documentation & Appeal Process

Answer Box: Renewing Brineura Coverage with Aetna in Michigan Start your Brineura renewal 60-90 days before expiration. Aetna requires updated clinical documentation showing motor function scores ≥1 on the CLN2 Clinical Rating Scale, plus physician notes demonstrating ongoing treatment benefit. Submit renewal through your prescribing neurologist or specialty center. If

Getting Hemgenix (etranacogene dezaparvovec) Approved by Humana in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Hemgenix Covered by Humana in Michigan Eligibility: Adults 18+ with severe/moderately severe hemophilia B, negative inhibitor test, 150+ Factor IX exposure days, and current prophylaxis. Fastest approval path: Submit complete prior authorization with hematologist letter, bleeding history, and lab results through Humana provider portal. Start today:

How to Get Kalydeco (Ivacaftor) Covered by Humana in Michigan: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Kalydeco Covered by Humana in Michigan Kalydeco (ivacaftor) requires prior authorization from Humana and costs approximately $369,255 annually without coverage. To get approved: (1) Submit PA request with CFTR genetic testing showing responsive mutation (G551D, R117H, etc.), (2) Include specialist documentation from CF center, (3) If

How to Get Ocrevus (Ocrelizumab) Covered by Blue Cross Blue Shield of Michigan: 2024 Prior Authorization Guide

Answer Box: Getting Ocrevus Covered by Blue Cross Blue Shield Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Ocrevus (ocrelizumab). Submit requests through the NovoLogix tool via Availity. If denied, you have 60 days for internal appeals and 127 days for external review through Michigan DIFS. First

How to Get Vanflyta (Quizartinib) Covered by Humana in Michigan: Complete Coding, Appeals, and Prior Authorization Guide

Answer Box: Getting Vanflyta Covered by Humana in Michigan Vanflyta (quizartinib) requires prior authorization from Humana for FLT3-ITD positive acute myeloid leukemia. Key requirements: FLT3-ITD test results, baseline EKG, and oncologist prescription. First step: Gather FLT3-ITD lab report and submit Humana's prior authorization form through their provider portal.

How to Get Hetlioz LQ (tasimelteon oral suspension) Covered by UnitedHealthcare in Michigan: Appeals Guide & Templates

Answer Box: Getting Hetlioz LQ Covered by UnitedHealthcare in Michigan Fast Track to Approval: UnitedHealthcare requires prior authorization for Hetlioz LQ (tasimelteon oral suspension) for pediatric Smith-Magenis syndrome patients ages 3-15. You need genetic testing confirming SMS diagnosis, specialist involvement, and documented sleep disturbances. If denied, you have internal appeals