Topic

Michigan

A collection of 444 issues

Do You Qualify for Alecensa (alectinib) Coverage by Blue Cross Blue Shield in Michigan? Decision Tree & Next Steps

Answer Box: Qualifying for Alecensa Coverage in Michigan Yes, you likely qualify if you have ALK-positive non-small cell lung cancer confirmed by molecular testing. Blue Cross Blue Shield of Michigan requires prior authorization through their OncoHealth portal. First step today: Have your oncologist gather ALK test results, staging documentation, and

How to Get Bylvay (odevixibat) Covered by Blue Cross Blue Shield of Michigan: Complete Appeals Guide with Forms and Deadlines

Answer Box: Getting Bylvay Covered in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Bylvay (odevixibat) for PFIC and Alagille syndrome. Your fastest path to approval: 1) Have your provider submit a complete PA request with diagnosis documentation and prior treatment failures, 2) If denied, file an

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

Quick Answer: Getting Ocrevus Covered by Aetna in Michigan Aetna (CVS Health) requires prior authorization for Ocrevus (ocrelizumab) in Michigan. Submit the Ocrevus Precertification Request form with MS diagnosis confirmation, neurologist prescription, and documentation of disease progression or relapse history. If denied, you have 180 days to appeal internally, then

Get Oxervate (Cenegermin) Covered by Blue Cross Blue Shield Michigan: Forms, Appeals & Prior Authorization Guide

Answer Box: Getting Oxervate Covered by BCBS Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Oxervate (cenegermin) to treat neurotrophic keratitis in patients 2+ years old. Fast track to approval: 1) Confirm stage 2/3 neurotrophic keratitis diagnosis with corneal sensitivity testing, 2) Document failed standard treatments

How to Get Elaprase (Idursulfase) Covered by Cigna in Michigan: Complete Guide to Prior Authorization, Appeals, and Billing Codes

Quick Answer: Getting Elaprase Covered by Cigna in Michigan Elaprase (idursulfase) requires prior authorization from Cigna and is covered under the medical benefit, not pharmacy. Your fastest path: Have your physician submit a PA request with enzymatic/genetic test results confirming Hunter syndrome (MPS II), weight-based dosing calculations (0.5

How to Get Soliris (Eculizumab) Covered by Humana in Michigan: Prior Authorization Guide and Appeal Templates

Answer Box: Getting Soliris (Eculizumab) Covered by Humana in Michigan Soliris requires prior authorization from Humana. Submit comprehensive clinical documentation including confirmed diagnosis (flow cytometry for PNH, antibody testing for gMG/NMOSD), vaccination records, and medical necessity justification. If denied, you have 65 days to appeal internally, then 127 days

How to Get Imbruvica (ibrutinib) Covered by Cigna in Michigan: Prior Authorization, Appeals, and Templates

Quick Answer: Getting Imbruvica Covered by Cigna in Michigan Cigna requires prior authorization for Imbruvica (ibrutinib) and often mandates step therapy with acalabrutinib or zanubrutinib first. If denied, you have 127 days to file an external review with Michigan DIFS after exhausting internal appeals. Start today: Have your oncologist submit

Work With Your Doctor to Get Duopa Covered by Humana in Michigan: Complete Provider Partnership Guide

Quick Answer: Your Path to Duopa Approval in Michigan Getting Duopa covered by Humana requires demonstrating advanced Parkinson's disease with motor fluctuations despite optimized oral therapy. Your fastest path: Schedule a visit with your neurologist to document failed oral medications, quantify "OFF" time (typically 3+ hours

How to Get Therakos CELLEX Photopheresis Covered by UnitedHealthcare in Michigan: Complete Appeal Guide with Forms and Timelines

Quick Answer: Getting Therakos CELLEX Covered by UnitedHealthcare in Michigan Therakos CELLEX photopheresis is covered by UnitedHealthcare for FDA-approved indications (CTCL) and guideline-supported conditions (steroid-refractory GVHD) when medical necessity criteria are met. Prior authorization is required through UnitedHealthcare's medical benefit, not pharmacy. If denied, you have two internal

Myths vs. Facts: Getting Elaprase (Idursulfase) Covered by Blue Cross Blue Shield in Michigan

Answer Box: Getting Elaprase Covered in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Elaprase (idursulfase) with specific diagnostic proof: enzyme testing showing iduronate-2-sulfatase deficiency plus genetic confirmation of IDS gene mutation. The fastest path is submitting complete documentation upfront—including weight-based dosing calculations (0.5 mg/