Topic

Michigan

A collection of 234 issues

Getting Aldurazyme (Laronidase) Covered by Humana in Michigan: Coding Guide for Prior Authorization Success

Answer Box: Getting Started Today Aldurazyme (laronidase) requires prior authorization from Humana in Michigan. The fastest path to approval: 1) Confirm MPS I diagnosis with genetic testing (ICD-10: E76.01, E76.02, or E76.03), 2) Submit PA request with complete clinical documentation including baseline assessments, and 3) Use correct

How to Get Jakafi (Ruxolitinib) Covered by UnitedHealthcare in Michigan: Complete Prior Authorization and Appeals Guide

Quick Answer: UnitedHealthcare requires prior authorization for Jakafi (ruxolitinib) with strict medical necessity criteria. You'll need FDA-approved diagnosis documentation, proof of failed prior therapies (like hydroxyurea for polycythemia vera), and current lab results. Submit through UHC's provider portal with comprehensive clinical documentation. If denied, you have

How to Get Lutathera Covered by Aetna in Michigan: Prior Authorization Forms, Timelines & Appeals Guide

Quick Answer: Getting Lutathera Covered by Aetna in Michigan Lutathera (lutetium Lu-177 dotatate) requires prior authorization from Aetna in Michigan. The fastest path to approval: (1) Complete Aetna's Lutathera Precertification Form with detailed clinical documentation including SSTR-positive imaging, (2) Submit via Availity portal or fax to 1-888-267-3277 at

Lowering Out-of-Pocket Costs for Acthar Gel with Aetna CVS Health in Michigan: Complete Coverage & Assistance Guide

Answer Box: Getting Acthar Gel Covered by Aetna CVS Health in Michigan Acthar Gel requires prior authorization from Aetna CVS Health in Michigan, with strict step therapy requiring documented failure of corticosteroids first. Your fastest path to approval: (1) Gather complete records of prior corticosteroid trials and outcomes, (2) Have

How to Get Firdapse (Amifampridine) Covered by UnitedHealthcare in Michigan: Complete Prior Authorization Guide with Appeals Process

Answer Box: Getting Firdapse Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Firdapse (amifampridine) in Michigan, with no step therapy required for confirmed LEMS patients. The fastest path to approval: (1) Ensure your neurologist has documented LEMS diagnosis with P/Q-type VGCC antibodies and EMG findings, (2) Submit

How to Get Firazyr (icatibant) Covered by Humana in Michigan: Prior Authorization Forms, Appeals, and Coding Requirements

Answer Box: Getting Firazyr Covered by Humana in Michigan Firazyr (icatibant) requires prior authorization from Humana for hereditary angioedema (HAE) treatment. Your fastest path: Have your HAE specialist submit a PA request through Humana's provider portal with HAE diagnosis (ICD-10: D84.1), attack history, and self-administration training documentation.

Renewing Stelara (Ustekinumab) Coverage with UnitedHealthcare in Michigan: 2025 Timeline, Forms, and Appeal Options

Quick Answer: Renewing Stelara Coverage with UnitedHealthcare in Michigan Important Update: UnitedHealthcare no longer covers brand-name Stelara as of September 2024. You must switch to preferred biosimilars (Steqeyma or Yesintek) or meet strict medical exception criteria. For renewals: submit documentation 30 days before current authorization expires, include clinical response evidence,

Getting Alprolix (Coagulation Factor IX) Covered by Aetna CVS Health in Michigan: Complete Prior Authorization and Appeals Guide

Quick Answer: Your Path to Alprolix Coverage To get Alprolix covered by Aetna CVS Health in Michigan: You'll need prior authorization from a board-certified hematologist, documentation of hemophilia B diagnosis with Factor IX ≤2%, and evidence of bleeding history. Submit through Aetna's provider portal with complete

How to Get Amvuttra (Vutrisiran) Covered by Humana in Michigan: Appeals, Alternatives, and Exception Strategies

Quick Answer: Getting Amvuttra (Vutrisiran) Approved by Humana in Michigan Amvuttra (vutrisiran) requires prior authorization from Humana for hereditary transthyretin-mediated amyloidosis with polyneuropathy (hATTR-PN). Most Humana Medicare plans don't list Amvuttra on their 2025 formularies, making a formulary exception request necessary. Your fastest path: (1) Have your prescriber

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

Quick Answer: Getting Nucala Covered by Cigna in Michigan Cigna requires prior authorization for Nucala (mepolizumab) in Michigan with specific eosinophil count criteria (≥300 cells/µL) and step therapy requirements. You'll likely need to try benralizumab or dupilumab first unless contraindicated. If denied, Michigan's DIFS external