Topic

New York

A collection of 495 issues

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

Answer Box: Quick Path to Translarna Coverage Translarna (ataluren) requires prior authorization from Cigna and is non-formulary, needing a formulary exception for nonsense mutation Duchenne muscular dystrophy (DMD). Your neuromuscular specialist must submit comprehensive documentation via the EviCore portal, including genetic confirmation of nonsense mutation and proof of ambulatory status.

How to Renew Orladeyo (Berotralstat) Coverage with Aetna CVS Health in New York: Timeline, Documentation & Appeals

Answer Box: Renewing Orladeyo Coverage with Aetna CVS Health in New York Orladeyo (berotralstat) requires annual reauthorization with Aetna CVS Health for HAE prophylaxis. Start renewal 60-90 days before expiration by documenting attack frequency reduction, submitting via Aetna's provider portal, and preparing appeal evidence if denied. New York

Getting Hemgenix (Etranacogene Dezaparvovec) Covered by Blue Cross Blue Shield in New York: PA Forms, Appeals, and Cost Assistance

Answer Box: Getting Hemgenix Covered by Blue Cross Blue Shield in New York Eligibility: Adults ≥18 with severe hemophilia B (Factor IX ≤2%) on prophylaxis or with serious bleeding history. Fastest Path: Submit prior authorization through your BCBS plan's provider portal with Factor IX levels, bleeding records, and

How to Get Xospata (Gilteritinib) Covered by Aetna CVS Health in New York: Complete Appeals Guide

Quick Answer: Getting Xospata (Gilteritinib) Covered by Aetna CVS Health in New York Xospata (gilteritinib) is covered on Aetna formularies as a specialty oncology drug requiring prior authorization, FLT3 mutation testing, and specialty pharmacy dispensing. Your fastest path to approval: 1) Confirm your Aetna plan covers Xospata via the member

How to Get Alecensa (alectinib) Covered by Blue Cross Blue Shield in New York: Complete Appeals Guide and Success Strategies

Answer Box: Getting Alecensa (alectinib) Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield of New York requires prior authorization for Alecensa (alectinib) in ALK-positive NSCLC patients. The fastest path to approval: (1) Submit ALK testing confirmation via FDA-approved methods (FISH, IHC, NGS), (2) Include complete

Myths vs. Facts: Getting Hemgenix (Etranacogene Dezaparvovec) Covered by Cigna in New York

Answer Box: Getting Hemgenix Covered by Cigna in New York Eligibility: Male patients ≥18 with severe hemophilia B (Factor IX ≤2%), ≥150 exposure days, negative AAV5 antibodies, and normal liver function qualify for Cigna coverage under policy IP_0535. Fastest path: Submit prior authorization with complete lab documentation (Factor IX

Do You Qualify for Skyrizi (risankizumab) Coverage by Blue Cross Blue Shield in New York? Decision Tree & Appeal Guide

Answer Box Getting Skyrizi (risankizumab) covered by Blue Cross Blue Shield in New York requires prior authorization with documented TNF inhibitor failure for IBD, or moderate-to-severe psoriasis (PASI ≥10-12, BSA ≥3%) for dermatology indications. Submit PA through your provider via Anthem's digital portal or fax with clinical documentation.

Do You Qualify for Tepezza Coverage by Humana in New York? Decision Tree & Appeals Guide

Answer Box: Your Fastest Path to Approval If you have thyroid eye disease (TED) with Clinical Activity Score ≥4, documented proptosis, and are euthyroid, Humana likely covers Tepezza under Medicare Part B with prior authorization. Submit through your ophthalmologist with complete documentation including CAS assessment, thyroid labs, and prior steroid

How to Get Kuvan (Sapropterin Dihydrochloride) Covered by Cigna in New York: Complete Timeline and Appeals Guide

Answer Box: Getting Kuvan Covered by Cigna in New York Cigna requires prior authorization for Kuvan (sapropterin dihydrochloride) prescribed by a PKU specialist, with documented BH4 responsiveness (≥20-30% phenylalanine reduction) and concurrent low-phenylalanine diet. Standard approval takes 1-5 days via electronic submission through CoverMyMeds or Cigna's portal. If

Do You Qualify for Ocrevus (Ocrelizumab) Coverage by Cigna in New York? Complete Decision Tree & Appeals Guide

Answer Box: Ocrevus Coverage by Cigna in New York Yes, you likely qualify if you have confirmed relapsing or primary progressive MS and have tried/failed at least one disease-modifying therapy. Cigna requires prior authorization through CoverMyMeds or fax (855-840-1678) with 5-day processing. First step today: Contact your neurologist to