Topic

Michigan

A collection of 447 issues

Renewing Hemlibra (Emicizumab) Coverage with Blue Cross Blue Shield Michigan: 2025 Renewal Guide and Timeline

Answer Box: Hemlibra Renewal with Blue Cross Blue Shield Michigan Blue Cross Blue Shield of Michigan requires annual prior authorization renewal for Hemlibra (emicizumab). Starting September 1, 2025, coverage moves from medical to pharmacy benefit for commercial members. Submit renewal requests 30-45 days before expiration with documented bleeding reduction and

How Long Does It Take to Get Enhertu Approved by UnitedHealthcare in Michigan? Timeline & Appeal Process

Answer Box: Getting Enhertu Covered by UnitedHealthcare in Michigan Timeline: UnitedHealthcare's OptumRx system can approve Enhertu in under 30 seconds through automated prior authorization if all criteria are met, or up to 30 days for manual review. First step: Have your oncologist submit the prior authorization through the

Myths vs. Facts: Getting StrataGraft Covered by Aetna (CVS Health) in Michigan - Prior Authorization Guide

Answer Box: StrataGraft Coverage by Aetna (CVS Health) in Michigan Eligibility: Adults 18+ with deep partial-thickness thermal burns requiring surgical intervention when autograft isn't available or feasible. Fastest path: Submit prior authorization via Aetna provider portal using HCPCS code J7353 with complete wound documentation, burn depth assessment, and

How to Get Aldurazyme (Laronidase) Covered by Blue Cross Blue Shield Michigan: Prior Authorization, Appeals, and State Review Process

Quick Answer: Getting Aldurazyme Covered by Blue Cross Blue Shield Michigan Eligibility: Blue Cross Blue Shield of Michigan covers Aldurazyme (laronidase) for mucopolysaccharidosis type I (MPS I) with prior authorization. Fastest path: Submit PA request through the Medical and Pharmacy Drug PA Portal with genetic/enzymatic confirmation of MPS I

How to Get Kymriah (Tisagenlecleucel) Covered by Aetna CVS Health in Michigan: Complete Guide to Approval, Appeals, and Cost-Saving Options

Answer Box: Getting Kymriah Covered by Aetna CVS Health in Michigan Aetna CVS Health covers Kymriah (tisagenlecleucel) for FDA-approved indications with prior authorization. For B-cell ALL patients under 26 or adults with relapsed/refractory DLBCL, treatment must occur at a certified center in Aetna's network. Start by having

How to Get Strensiq (Asfotase Alfa) Covered by Aetna in Michigan: Complete Guide to Prior Authorization, Appeals, and Cost Assistance

Answer Box: Getting Strensiq Covered by Aetna in Michigan Fastest path to approval: Aetna requires prior authorization for Strensiq (asfotase alfa) with strict clinical criteria. You need documented perinatal/infantile or juvenile-onset hypophosphatasia, genetic testing or biochemical confirmation, and proof the condition started before age 18. First step today: Contact

How to Get Stelara (Ustekinumab) Covered by Blue Cross Blue Shield of Michigan: Timeline, Forms, and Appeals Guide

Quick Answer: Getting Stelara Covered by BCBS Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Stelara (ustekinumab). Key change: Starting April 1, 2025, BCBS Michigan will only cover Yesintek (ustekinumab biosimilar) for most commercial members, not brand-name Stelara. You'll need step therapy (trying preferred alternatives

The Requirements Checklist to Get Advate (octocog alfa) Covered by Blue Cross Blue Shield in Michigan

Answer Box: Getting Advate Covered in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Advate (octocog alfa) for hemophilia A treatment. The fastest path to approval: (1) Submit complete PA request with Factor VIII inhibitor test results and clinical documentation via provider portal, (2) Include medical necessity

Resources to Get Xenpozyme (olipudase alfa-rpcp) Approved with UnitedHealthcare in Michigan: Forms, Portals & Contacts

Quick Start: Getting Xenpozyme Covered by UnitedHealthcare in Michigan Xenpozyme (olipudase alfa-rpcp) requires prior authorization from UnitedHealthcare/OptumRx for coverage approval. Your fastest path: verify your Michigan plan's specialty drug benefits, gather ASMD diagnosis documentation, and submit the PA request through the UnitedHealthcare Provider Portal or OptumRx electronic

Get Thiola (Tiopronin) Covered by Humana in Michigan: Decision Tree, Forms & Appeals Guide

Answer Box: Quick Eligibility & First Steps Do you qualify for Thiola coverage by Humana in Michigan? If you have confirmed cystinuria with elevated urine cystine (>300-400 mg/day) and documented stone formation, you likely qualify. Fastest path: Have your urologist/nephrologist submit a prior authorization request with 24-hour