Topic

Michigan

A collection of 234 issues

Myths vs. Facts: Getting Stelara (Ustekinumab) Covered by Aetna CVS Health in Michigan

Answer Box: Getting Stelara (ustekinumab) covered by Aetna CVS Health in Michigan requires prior authorization with documented step therapy failure and TB screening. The fastest path: 1) Submit complete PA request with specialist prescription and prior treatment history, 2) If denied, file internal appeal within 180 days, 3) Request Michigan

How to Get Voydeya (danicopan) Covered by UnitedHealthcare in Michigan: Prior Authorization Forms, Appeals, and Approval Timeline

Quick Answer: Your Path to Voydeya Coverage in Michigan Getting Voydeya (danicopan) covered by UnitedHealthcare in Michigan requires prior authorization with specific documentation: confirmed PNH diagnosis by flow cytometry, evidence of extravascular hemolysis despite C5 inhibitor therapy, completed REMS program enrollment, and current vaccination records (MenACWY and MenB). Submit through

How to Get Oxlumo (lumasiran) Covered by Humana in Michigan: Complete Guide with Forms and Appeal Process

Quick Answer: Getting Oxlumo (lumasiran) Covered by Humana in Michigan Oxlumo requires prior authorization from Humana Medicare Advantage plans. To get approved: (1) Confirm PH1 diagnosis with genetic testing for AGXT mutations, (2) Submit PA request through CenterWell Specialty Pharmacy with urinary oxalate levels and specialist prescription, (3) If denied,

Coding That Helps Get Voydeya (Danicopan) Approved by Blue Cross Blue Shield of Michigan (ICD-10, HCPCS/J-Code, NDC)

Answer Box: Getting Voydeya Coded Correctly for BCBSM Approval Key codes for Voydeya (danicopan) in Michigan: Use ICD-10 D59.5 for PNH diagnosis, HCPCS J8499 for billing, and specific NDCs (25682-043-04, 25682-043-92, etc.). BCBSM requires flow cytometry confirmation, 6+ months on C5 inhibitor therapy, and recent transfusion documentation. Submit through

Get Vanflyta (Quizartinib) Covered by Aetna in Michigan: Alternatives, Appeals & Authorization Guide

Quick Answer: Getting Vanflyta Covered by Aetna in Michigan Vanflyta (quizartinib) requires prior authorization from Aetna CVS Health. If initially denied, you have strong appeal rights in Michigan with 127 days to file external review through DIFS. Start today by: (1) Confirming your FLT3-ITD test results are documented, (2) Having

How to Get Firazyr (Icatibant) Covered by Aetna in Michigan: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Firazyr Covered by Aetna in Michigan Aetna requires prior authorization for Firazyr (icatibant) in Michigan. The fastest path to approval: (1) Gather HAE diagnosis documentation (C4, C1-INH levels), (2) Complete Aetna's Firazyr precertification form, and (3) Submit through your provider's Aetna portal or

Myths vs. Facts: Getting Amondys 45 (casimersen) Covered by Aetna (CVS Health) in Michigan - Complete 2025 Guide

Quick Answer: Getting Amondys 45 (casimersen) Covered by Aetna (CVS Health) in Michigan Eligibility: Requires genetic testing confirming DMD with exon 45-skippable mutation, specialist prescription, and documented ambulatory function (≥300m on 6-minute walk test). Fastest path: Submit complete Aetna precertification form with genetic report, specialist notes, and functional assessments. First

Get Xyrem (Sodium Oxybate) Covered by UnitedHealthcare in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Xyrem Covered by UnitedHealthcare in Michigan To get Xyrem (sodium oxybate) covered by UnitedHealthcare in Michigan, you'll need prior authorization through OptumRx. First, ensure REMS enrollment is complete at XywavXyremREMS.com. Then submit a prior authorization request with sleep study results, documented narcolepsy diagnosis, and

How to Get Mycapssa (Octreotide Oral) Covered by UnitedHealthcare in Michigan: Prior Authorization Guide and Appeal Strategies

Quick Answer: Getting Mycapssa Covered by UnitedHealthcare in Michigan Mycapssa (octreotide oral) requires prior authorization from UnitedHealthcare in Michigan. To get approved: (1) Ensure you have documented acromegaly with abnormal GH/IGF-1 levels, (2) Show prior response to injectable octreotide or lanreotide, and (3) Provide clinical justification for switching from

How to Get Cerezyme (Imiglucerase) Covered by Cigna in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Cerezyme Covered by Cigna in Michigan Eligibility: Cigna covers Cerezyme (imiglucerase) for confirmed Type 1 Gaucher disease with prior authorization through the medical benefit. No step therapy is required. Fastest path: Have your specialist submit a PA request via CoverMyMeds or Cigna's provider portal with