Topic

Michigan

A collection of 415 issues

How to Get Raxone (idebenone) Covered by UnitedHealthcare in Michigan: Prior Authorization Guide and Appeals Process

Answer Box: Getting Raxone Covered by UnitedHealthcare in Michigan UnitedHealthcare typically requires prior authorization for Raxone (idebenone) in Michigan, with decisions usually made within 24-72 hours for urgent cases and up to 14 days for standard requests. Since Raxone isn't FDA-approved for LHON in the U.S., coverage

Breyanzi (Lisocabtagene Maraleucel) Approval with UnitedHealthcare in Michigan: Answers to the Most Common Questions

Answer Box: Getting Breyanzi Covered by UnitedHealthcare in Michigan Breyanzi (lisocabtagene maraleucel) requires prior authorization from UnitedHealthcare for all Michigan plans. Your oncologist must submit documentation proving you meet FDA criteria: relapsed/refractory large B-cell lymphoma after ≥2 lines, or CLL/SLL after BTK and BCL-2 inhibitor failure. Treatment must

Coding That Helps Get Rapivab (Peramivir) Approved by Aetna CVS Health in Michigan: ICD-10, HCPCS J-Code, and NDC Guide

Answer Box: Getting Rapivab (Peramivir) Covered by Aetna CVS Health in Michigan Rapivab (peramivir) requires proper medical benefit coding for Aetna CVS Health approval in Michigan. Use HCPCS J2547 (1 mg per unit), bill 600 units for standard adult dose, pair with ICD-10 J10.1 or J11.1 for uncomplicated

Lowering Out-of-Pocket for Evrysdi (risdiplam) with Aetna (CVS Health) in Michigan: Copay, Tiering & Assistance

Answer Box: Fastest Path to Lower Evrysdi Costs in Michigan Evrysdi (risdiplam) requires prior authorization with Aetna and typically sits on a high specialty tier. To minimize costs: (1) Apply for Genentech's copay program at EvrysdiCopay.com (up to $25,000 annually for commercial insurance), (2) Ask your

Lowering Out-of-Pocket Costs for Procysbi with UnitedHealthcare in Michigan: Copay Cards, Tier Exceptions & Appeals

Answer Box: Getting Procysbi Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Procysbi (cysteamine bitartrate DR) and typically mandates step therapy with immediate-release cysteamine first. Michigan residents have 180 days to appeal denials internally, then 127 days for external review through Michigan DIFS. First step: Have your doctor

Myths vs. Facts: Getting Ofev (nintedanib) Covered by Humana in Michigan (2025 Appeals Guide)

Answer Box: Getting Ofev (nintedanib) Covered by Humana in Michigan Eligibility: Humana typically requires prior authorization for Ofev, with pulmonologist attestation, HRCT confirming IPF/UIP pattern, and baseline PFTs. Fastest path: Submit complete PA documentation through Humana's provider portal with all required clinical evidence. First step today: Verify

How to Get Zolgensma (onasemnogene abeparvovec) Covered by UnitedHealthcare in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by UnitedHealthcare in Michigan Fastest Path to Approval: UnitedHealthcare requires prior authorization for Zolgensma through their medical benefit policy. You need genetic testing confirming bi-allelic SMN1 mutations, age under 24 months at infusion, anti-AAV9 antibody titer ≤1:50, and treatment at a certified center. If

The Requirements Checklist to Get Koselugo (Selumetinib) Covered by Cigna in Michigan: Forms, Appeals, and Clinical Criteria

Answer Box: Quick Path to Koselugo Coverage Cigna requires prior authorization (PA) for Koselugo (selumetinib) in pediatric NF1 patients with symptomatic, inoperable plexiform neurofibromas. Initial approvals last 1 year with reauthorization requiring evidence of benefit. Key requirements: confirmed NF1 diagnosis (ICD-10 Q85.01), baseline LVEF evaluation, ophthalmologic exam, and MRI

How to Get Rebif (Interferon Beta-1a) Covered by Cigna in Michigan: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Rebif Covered by Cigna in Michigan Rebif (interferon beta-1a) requires prior authorization from Cigna, typically managed through Express Scripts/Accredo specialty pharmacy. Submit initial PA via CoverMyMeds or Cigna provider portal with MS diagnosis, prior DMT failures, and medical necessity documentation. If denied, file internal appeal within

The Requirements Checklist to Get Luxturna (voretigene neparvovec-rzyl) Covered by Cigna in Michigan

Quick Answer: To get Luxturna covered by Cigna in Michigan, you need genetic testing confirming biallelic RPE65 mutations, retinal viability proof via OCT, and treatment at University of Michigan Kellogg Eye Center. Submit Cigna's Luxturna CCRD Prior Authorization Form to fax 833-910-1625 with all supporting docs. If denied,