Topic

Michigan

A collection of 415 issues

How to Get Helixate (Antihemophilic Factor, rFVIII) Covered by Aetna CVS Health in Michigan: Complete Coverage Guide with Appeals Process

Quick Answer: Getting Helixate Covered by Aetna CVS Health in Michigan Important Update: Helixate (antihemophilic factor, rFVIII) has been discontinued by the manufacturer. Aetna CVS Health now covers alternative factor VIII products like Kovaltry, Advate, and Jivi with prior authorization. First step: Contact your hematologist to select an alternative and

How to Get Skyrizi (risankizumab) Covered by Blue Cross Blue Shield of Michigan: Prior Authorization Guide and Appeals Process

Quick Answer: Getting Skyrizi Covered by Blue Cross Blue Shield of Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Skyrizi (risankizumab) with specific step therapy requirements. For Crohn's disease, you need documented failure of conventional therapy (steroids for ≥7 days, immunomodulators for ≥2 months). Submit

How to Get Aldurazyme (Laronidase) Covered by Aetna (CVS Health) in Michigan: Complete Timeline & Appeals Guide

Answer Box: Getting Aldurazyme Covered by Aetna (CVS Health) in Michigan Aldurazyme (laronidase) requires prior authorization from Aetna (CVS Health) for all Michigan plans. The fastest approval path involves: (1) confirming MPS I diagnosis with genetic/enzyme testing, (2) having your specialist submit complete PA documentation via Availity portal, and

How to Get Prolastin-C (Alpha1-Proteinase Inhibitor) Covered by Cigna in Michigan: Complete PA Guide and Appeals Process

Answer Box: Getting Prolastin-C Covered by Cigna in Michigan Cigna requires prior authorization for Prolastin-C (alpha1-proteinase inhibitor) with step therapy preference over Zemaira. Key requirements: severe AAT deficiency (genotype Pi*ZZ or equivalent), serum AAT <80 mg/dL, emphysema documentation, and non-smoker status. First step today: Have your pulmonologist

Myths vs. Facts: Getting Natpara (Parathyroid Hormone) Covered by Aetna CVS Health in Michigan

Important Update: Takeda will permanently discontinue all Natpara shipments on December 31, 2025. New patient starts are typically denied due to no commercial supply. If you're currently on Natpara through the Special Use Program, work with your endocrinologist immediately to plan your transition to alternatives like Yorvipath or

The Requirements Checklist to Get Strimvelis Gene Therapy Covered by Cigna in Michigan: Forms, Appeals, and Milan Treatment Guide

Answer Box: Getting Strimvelis Covered by Cigna in Michigan Strimvelis requires prior authorization through Cigna's Express Scripts specialty pharmacy division using their Non-Specific Gene Therapy form. Key requirements: confirmed ADA-SCID diagnosis with bi-allelic ADA gene mutations, documented absence of HLA-matched related donor, and failed/contraindicated PEG-ADA enzyme replacement

How to Get Tysabri (natalizumab) Covered by Cigna in Michigan: PA Forms, Appeals Timeline & Approval Checklist

Answer Box: Getting Tysabri Covered by Cigna in Michigan Cigna requires prior authorization for Tysabri (natalizumab) in Michigan with step therapy requirements or documented highly active MS. The fastest path: (1) Have your neurologist submit PA via Evicore by Evernorth or CoverMyMeds with JCV antibody results, recent MRI reports, and

Getting Zanzalintinib (XL092) Covered by UnitedHealthcare in Michigan: Clinical Trials, Compassionate Use, and Appeals Guide 2025

Answer Box: Your Path to Zanzalintinib Access Zanzalintinib (XL092) is an investigational drug not yet FDA-approved. UnitedHealthcare typically denies coverage outside clinical trials. Your fastest path: 1) Search active trials at ClinicalTrials.gov for "XL092" or contact your oncologist about STELLAR program studies, 2) If trial-ineligible, pursue Exelixis

How to Get Hetlioz LQ (Tasimelteon Oral Suspension) Covered by Humana in Michigan: Prior Authorization Guide with Forms and Appeal Timelines

Quick Answer: Hetlioz LQ (tasimelteon oral suspension) for Smith-Magenis syndrome in children 3-15 years typically requires Humana prior authorization with genetic confirmation and sleep specialist documentation. Submit PA electronically through Humana's provider portal with weight-based dosing calculations. If denied, you have 65 days to appeal. Michigan offers external

How to Get Firdapse (Amifampridine) Covered by Cigna in Michigan: Complete Prior Authorization Guide

Answer Box Getting Firdapse (amifampridine) covered by Cigna in Michigan requires prior authorization with specific LEMS diagnostic proof. Michigan residents have strong appeal rights through DIFS external review within 127 days of denial. Fastest path: (1) Have your neurologist complete Cigna's PA form with EMG/antibody results, (2)