Topic

Michigan

A collection of 448 issues

How to Get Acthar Gel Covered by Cigna in Michigan: Prior Authorization, Appeals, and Formulary Alternatives Guide

Answer Box: Getting Acthar Gel Covered by Cigna in Michigan Cigna requires prior authorization and step therapy for Acthar Gel (repository corticotropin injection) in Michigan. You'll need documented failure or contraindication to preferred alternatives like prednisone or IV methylprednisolone. If denied, Michigan gives you 127 days to file

How to Get Elevidys (Delandistrogene Moxeparvovec-Rokl) Covered by Humana in Michigan: Forms, Appeals, and State Protections

Quick Answer: Getting Elevidys Covered by Humana in Michigan Elevidys requires prior authorization from Humana Medicare Advantage plans. Your fastest path: 1) Gather DMD genetic testing, prior steroid therapy records, and functional assessments; 2) Have your prescriber submit a complete PA request with medical necessity documentation; 3) If denied, file

Coding That Helps Get Darzalex/Darzalex Faspro (Daratumumab) Approved by Humana in Michigan: ICD-10, J-Codes & Appeal Guide

Answer Box: Getting Darzalex/Darzalex Faspro Covered by Humana in Michigan Humana requires prior authorization for Darzalex (daratumumab) in 2024. The fastest path to approval: ensure proper ICD-10 coding (C90.00-C90.02 for multiple myeloma, E85.4/E85.9 for AL amyloidosis), use correct HCPCS code J9144 for Faspro billing,

How to Get Adynovate Covered by UnitedHealthcare in Michigan: Prior Authorization, Appeals, and State Protections

Quick Answer: Getting Adynovate Covered by UnitedHealthcare in Michigan Adynovate (bdanocog alfa pegol) requires prior authorization from UnitedHealthcare/OptumRx in Michigan. Submit your PA request through the UnitedHealthcare Provider Portal or call 800-903-5253 for Medicaid plans. If denied, you have strong appeal rights under Michigan's Patient's

How to Get Pomalyst (Pomalidomide) Covered by Humana in Michigan: Prior Authorization Guide & Appeal Templates

Answer Box: Getting Pomalyst (Pomalidomide) Covered by Humana in Michigan Fastest path to approval: Submit prior authorization with documented failure of both lenalidomide and a proteasome inhibitor, plus oncologist letter confirming medical necessity. If denied, file internal appeal within 65 days, then request Michigan DIFS external review within 127 days.

How to Get Dupixent (dupilumab) Covered by Cigna in Michigan: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Started To get Dupixent (dupilumab) covered by Cigna in Michigan, you'll need prior authorization through their specialty pharmacy network. The fastest path: (1) Have your doctor submit a PA request via CoverMyMeds or the Cigna provider portal with complete clinical documentation, (2) Set up specialty

How to Get Uplizna (inebilizumab) Covered by Cigna in Michigan: Medical Necessity Criteria & Appeal Process

Answer Box: Getting Uplizna (inebilizumab) Covered by Cigna in Michigan Cigna requires prior authorization for Uplizna (inebilizumab) with specific medical necessity criteria: You must be 18+ with AQP4-positive NMOSD or IgG4-related disease, prescribed by/with a neurologist, and have completed HBV screening. Fastest path: Complete Cigna's prior authorization

How to Get Signifor LAR (Pasireotide) Covered by Aetna in Michigan: Prior Authorization Forms and Appeal Guide

Answer Box: Getting Signifor LAR Covered by Aetna in Michigan Aetna requires prior authorization for Signifor LAR (pasireotide) in Michigan. You must document trial and failure of Somatuline Depot (lanreotide) first, plus provide biochemical evidence (elevated UFC for Cushing's disease or IGF-1 for acromegaly). Submit via CVS Specialty

How to Get Jynarque (Tolvaptan) Covered by UnitedHealthcare in Michigan: Complete PA Guide with Appeal Scripts

Answer Box: Getting Jynarque Covered by UnitedHealthcare in Michigan Quick Path to Approval: UnitedHealthcare requires prior authorization for Jynarque (tolvaptan) with documented ADPKD diagnosis and rapid progression evidence. First step today: Ensure your prescriber and you are enrolled in the mandatory REMS program, then gather 4+ years of eGFR decline

Renewing Fintepla (Fenfluramine) Coverage with Aetna CVS Health in Michigan: Documentation Guide and Timeline

Answer Box: Fintepla (fenfluramine) renewal with Aetna CVS Health in Michigan requires documented seizure frequency reduction, current echocardiogram results, and REMS compliance. Start renewal process 60 days before current authorization expires. Submit seizure logs, cardiac monitoring results, and prescriber attestation through Aetna's provider portal or CVS Caremark. Most