Topic

New York

A collection of 235 issues

How Long Does It Take to Get Prolastin-C Approved by UnitedHealthcare in New York? Complete Timeline & Appeals Guide

Answer Box: Getting Prolastin-C Approved by UnitedHealthcare in New York Timeline: Standard prior authorization decisions take 72 hours; expedited requests get 24-hour turnaround. Requirements: Pi*ZZ genotype confirmation, lung function tests showing impairment, and often trial/failure of preferred alternatives (Aralast NP, Glassia, Zemaira). First step: Gather complete documentation and

Cigna's Coverage Criteria for Qinlock (Ripretinib) in New York: What Counts as "Medically Necessary"?

Quick Answer: Getting Qinlock (Ripretinib) Covered by Cigna in New York Cigna requires prior authorization for Qinlock (ripretinib) and enforces strict step therapy: you must have tried and failed imatinib, sunitinib, and regorafenib first. Medical necessity requires documented GIST diagnosis, progression after these three therapies, and oncologist prescription. First step

Work With Your Doctor to Get Mycapssa (Octreotide, Oral) Approved by UnitedHealthcare in New York: Provider Partnership Guide

Quick Answer: Getting Mycapssa Covered in New York To get Mycapssa (octreotide, oral) approved by UnitedHealthcare in New York, you'll need to work closely with your endocrinologist to document prior response to injectable octreotide/lanreotide, submit comprehensive prior authorization with medical necessity justification, and be prepared for peer-to-peer

How to Get Myozyme (Alglucosidase Alfa) Covered by Blue Cross Blue Shield in New York: Appeals Guide and State Protections

Answer Box: Getting Myozyme Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield in New York requires prior authorization for Myozyme (alglucosidase alfa) with confirmed Pompe disease diagnosis and specialist involvement. The fastest path to approval: (1) Ensure your metabolic/genetic specialist has documented enzyme deficiency

How to Get Ultomiris (Ravulizumab) Approved by Cigna in New York: Complete Guide to Coverage and Appeals

Answer Box: Getting Ultomiris Covered by Cigna in New York Cigna requires prior authorization for Ultomiris (ravulizumab) in New York for all FDA-approved conditions: PNH, aHUS, generalized myasthenia gravis, and NMOSD. The fastest path to approval: Have your specialist complete Cigna's Ultomiris PA form with complete diagnosis documentation,

How to Get Tysabri (Natalizumab) Covered by Cigna in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tysabri Covered by Cigna in New York Tysabri (natalizumab) requires prior authorization from Cigna and is covered under the medical benefit as a specialty infusion. Key requirements: TOUCH program enrollment for patient, prescriber, and infusion site; documented failure of at least one MS therapy; current MRI and

How to Get Uptravi (Selexipag) Covered by UnitedHealthcare in New York: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Uptravi Covered by UnitedHealthcare in New York Uptravi (selexipag) requires prior authorization from UnitedHealthcare for pulmonary arterial hypertension (PAH) patients in New York. Your fastest path to approval: 1. Confirm WHO Group I PAH diagnosis with right heart catheterization results 2. Document step therapy (failed PDE5 inhibitors

How to Get Rylaze (Asparaginase Erwinia Chrysanthemi) Covered by Cigna in New York: Complete Appeals Guide with State Protections

Answer Box: Getting Rylaze Covered by Cigna in New York Rylaze (asparaginase erwinia chrysanthemi) requires prior authorization from Cigna, with specific documentation of hypersensitivity to E. coli-derived asparaginase. Your fastest path to approval: (1) Gather proof of allergic reaction to Oncaspar/pegaspargase, (2) Have your oncologist complete Cigna's

Get Spinraza (Nusinersen) Covered by Cigna in New York: Complete Prior Authorization and Appeal Guide

Answer Box: Fast Track to Spinraza Coverage Getting Spinraza (nusinersen) covered by Cigna in New York requires prior authorization with genetic confirmation of 5q SMA, specialist prescription, and motor function documentation. Your fastest path: (1) Have your neurologist complete Cigna's Spinraza PA form with genetic test results and

How to Get Cometriq (Cabozantinib) Covered by Humana in New York: Complete Prior Authorization Guide

Answer Box: Getting Cometriq Covered by Humana in New York Cometriq (cabozantinib) requires prior authorization from Humana Medicare Advantage and Part D plans. Your oncologist must submit documentation proving progressive, metastatic medullary thyroid carcinoma (ICD-10: C73) with evidence the disease isn't surgically curable. Fastest path: Have your oncologist