Topic

Michigan

A collection of 234 issues

Get Keytruda (Pembrolizumab) Covered by UnitedHealthcare in Michigan: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Keytruda Covered by UnitedHealthcare in Michigan Yes, UnitedHealthcare covers Keytruda (pembrolizumab) but requires prior authorization. Your doctor submits the request through the UnitedHealthcare Provider Portal with your diagnosis, biomarker results (like PD-L1 testing), and prior treatment history. If denied, you have 127 days to file an external

UnitedHealthcare's Coverage Criteria for Upstaza (Eladocagene Exuparvovec) in Michigan: What Counts as "Medically Necessary"?

Answer Box: Getting Upstaza Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Upstaza (eladocagene exuparvovec/Kebilidi) gene therapy with strict medical necessity criteria. To qualify, you need: (1) genetic confirmation of biallelic DDC mutations, (2) documented AADC deficiency symptoms, (3) patient age ≥18 months, and (4) treatment at

Do You Qualify for Pomalyst (pomalidomide) Coverage by Cigna in Michigan? Decision Tree & Next Steps

Answer Box: Quick Qualification Check Most likely to qualify: Patients 18+ with multiple myeloma who've failed both lenalidomide (Revlimid) and a proteasome inhibitor (like bortezomib), with documented progression within 60 days of last therapy. Fastest path: Have your oncologist submit prior authorization through Cigna's provider portal

How to Get Dojolvi (Triheptanoin) Covered by Cigna in Michigan: Appeals Guide and PA Requirements

Answer Box: Getting Dojolvi Covered by Cigna in Michigan Fastest path to approval: Submit prior authorization with molecular confirmation of LC-FAOD, documentation of failed alternative therapies, and specialist letter of medical necessity. If denied, file internal appeal within 180 days, then Michigan DIFS external review within 127 days. Start today:

How to Get Eylea and Lucentis Covered by Aetna CVS Health in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Started To get Eylea or Lucentis covered by Aetna CVS Health in Michigan: First, ensure your ophthalmologist tries bevacizumab (Avastin) unless contraindicated—Aetna requires step therapy. Submit prior authorization with OCT imaging showing retinal thickness ≥300 microns, visual acuity ≤20/40, and documented medical necessity. If denied,

How to Get Photrexa (Riboflavin) Covered by Aetna CVS Health in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Photrexa Coverage Aetna CVS Health requires prior authorization for Photrexa (riboflavin ophthalmic solution) corneal cross-linking in Michigan. Key requirements: progressive keratoconus documented by serial Kmax readings (≥1 diopter increase over 12 months), corneal thickness ≥400 microns, and use of FDA-approved iLink system. Submit via Aetna&

How to Get Voxzogo (Vosoritide) Covered by Aetna CVS Health in Michigan: Complete 2025 Guide with Forms and Appeals

Quick Answer: Getting Voxzogo Covered by Aetna CVS Health in Michigan Aetna CVS Health covers Voxzogo (vosoritide) for pediatric achondroplasia patients with open growth plates. Your fastest path to approval: (1) Confirm your child has documented achondroplasia via genetic testing or clinical/X-ray findings, (2) Verify open epiphyses through imaging,

Blue Cross Blue Shield of Michigan's Coverage Criteria for Retevmo (Selpercatinib): Complete Prior Authorization and Appeal Guide

Answer Box: Getting Retevmo Covered by BCBSM Fastest path to approval: Submit prior authorization with FDA-approved RET fusion test results, documented treatment history, baseline ECG showing QTc <500ms, and a detailed medical necessity letter citing FDA labeling. First step today: Contact BCBSM member services at the number on your

How to Get Rebif (Interferon Beta-1a) Covered by Humana in Michigan: Appeals Guide with Forms and Timelines

Answer Box: Getting Rebif Covered by Humana in Michigan Rebif (interferon beta-1a) is not on Humana's preferred drug list, requiring a formulary exception or appeal for coverage. In Michigan, you have 65 days to appeal a Humana denial, with decisions due within 7 days (72 hours if expedited)

How to Get StrataGraft Covered by UnitedHealthcare in Michigan: Prior Authorization Guide and Appeals Timeline

Quick Answer: Getting StrataGraft Covered by UnitedHealthcare in Michigan StrataGraft requires prior authorization from UnitedHealthcare as a facility-billed medical benefit (not pharmacy). The fastest path: Submit PA through the UHC Provider Portal with complete burn documentation, wound measurements, and proof that autograft isn't feasible. Standard decisions take up