Topic

Michigan

A collection of 415 issues

How to Get Hetlioz LQ (Tasimelteon Oral Suspension) Covered by Aetna CVS Health in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Hetlioz LQ Covered by Aetna CVS Health in Michigan Hetlioz LQ (tasimelteon oral suspension) requires prior authorization from Aetna CVS Health for pediatric patients (3-15 years) with Smith-Magenis syndrome. Submit electronically via Caremark.com/epa with genetic confirmation, weight-based dosing calculations, and specialist documentation. If denied, you

How to Get Onpattro (patisiran) Covered by UnitedHealthcare in Michigan: Complete Renewal Guide with Appeals Process

Answer Box: Getting Onpattro Covered by UnitedHealthcare in Michigan Onpattro (patisiran) requires prior authorization from UnitedHealthcare in Michigan for hereditary transthyretin-mediated amyloidosis polyneuropathy (hATTR-PN). Submit requests through the UHC Provider Portal with genetic testing, neurologist evaluation, and functional scores (mNIS+7, 6MWT, PND ≤IIIb). UnitedHealthcare must respond within 15 days

How to Get Besponsa (Inotuzumab Ozogamicin) Covered by Cigna in Michigan: Complete Approval Guide

Quick Answer: Getting Besponsa Covered by Cigna in Michigan To get Besponsa (inotuzumab ozogamicin) covered by Cigna in Michigan, you need prior authorization with documentation of CD22-positive B-cell precursor ALL that's relapsed or refractory. Submit Cigna's Besponsa CCRD form with pathology confirming CD22 expression, prior therapy

How to Get Pombiliti (Cipaglucosidase Alfa) Covered by UnitedHealthcare in Michigan: Complete Prior Authorization and Appeals Guide

Quick Answer: Pombiliti (cipaglucosidase alfa) requires prior authorization from UnitedHealthcare in Michigan. You'll need confirmed late-onset Pompe disease diagnosis, weight ≥40 kg, and documented lack of improvement on prior enzyme replacement therapy. Submit through OptumRx with GAA enzyme results, genetic testing, and ERT failure documentation. If denied, use

The Requirements Checklist to Get Zolgensma (onasemnogene abeparvovec) Covered by Aetna (CVS Health) in Michigan

Answer Box: Getting Zolgensma Covered by Aetna (CVS Health) in Michigan Aetna requires prior authorization for Zolgensma (onasemnogene abeparvovec) via CVS Specialty Pharmacy. Key requirements: age under 24 months, bi-allelic SMN1 mutations, anti-AAV9 antibody titer ≤1:50, and treatment at a certified gene therapy center. Submit the Zolgensma Medication Precertification

How to Get Jynarque (Tolvaptan) Covered by Blue Cross Blue Shield of Michigan: Complete Guide to Prior Authorization, Appeals, and Medical Necessity

Answer Box: Getting Jynarque Covered in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Jynarque (tolvaptan) with strict criteria: confirmed ADPKD diagnosis, Mayo Class 1C-1E rapid progression, eGFR ≥25 mL/min/1.73m², and REMS enrollment. First step today: Have your nephrologist obtain the BCBSM Jynarque PA

Coding That Helps Get Juxtapid (lomitapide) Approved by Cigna in Michigan: ICD-10, HCPCS, and NDC Guide

Answer Box: Getting Juxtapid (lomitapide) Coded Correctly for Cigna Coverage in Michigan Juxtapid (lomitapide) requires precise coding to avoid Cigna denials in Michigan. Use ICD-10 code E78.010 (homozygous familial hypercholesterolemia) effective 2025, HCPCS code J8499 (oral non-chemotherapeutic drug, NOS), and verify NDC numbers for specific capsule strengths through the

How to Get Vitrakvi (Larotrectinib) Covered by Humana in Michigan: Complete PA Guide and Appeal Process

Quick Answer: Vitrakvi (larotrectinib) requires prior authorization from Humana in Michigan as a Tier 5 specialty drug. Submit the Medicare Prescription Drug Coverage Determination form with NTRK fusion test results, oncologist notes, and prior therapy documentation to fax 877-486-2621. Standard approval takes 72 hours; expedited requests are decided in 24

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

Answer Box: Getting Translarna Coverage Through UnitedHealthcare in Michigan Translarna (ataluren) is not FDA-approved and generally excluded by UnitedHealthcare, but coverage may be possible through formulary exceptions. Your fastest path: 1) Verify your plan type and referral needs via the member portal, 2) Have a neuromuscular specialist submit a comprehensive

Myths vs. Facts: Getting Hemgenix (Etranacogene Dezaparvovec) Covered by Blue Cross Blue Shield in Michigan

Answer Box: Getting Hemgenix Covered in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Hemgenix and mandates trying Beqvez first for most commercial members as of November 2024. Submit medical drug PA through OncoHealth via Availity, including hemophilia B diagnosis, failed prophylaxis history, and Beqvez trial documentation.