Topic

New York

A collection of 419 issues

How to Get Brineura (Cerliponase Alfa) Covered by Aetna (CVS Health) in New York: Complete Appeals Guide

Answer Box: Getting Brineura Covered by Aetna (CVS Health) in New York Aetna requires prior authorization for Brineura (cerliponase alfa) under the medical benefit for pediatric CLN2 patients ≥3 years with confirmed TPP1 deficiency and motor function scores ≥1. Submit via neurologist with diagnosis confirmation, CLN2 Clinical Rating Scale scores,

Get Pomalyst (Pomalidomide) Covered by Blue Cross Blue Shield in New York: Complete Appeals Guide

Answer Box: Fastest Path to Pomalyst Coverage Pomalyst (pomalidomide) requires prior authorization from Blue Cross Blue Shield plans in New York. Success depends on documenting progression after ≥2 prior therapies including lenalidomide and a proteasome inhibitor, REMS program enrollment, and oncologist prescription with dexamethasone combination. If denied, New York'

The Complete Guide to Getting Zolgensma (Onasemnogene Abeparvovec) Covered by Cigna in New York

Quick Answer: Getting Zolgensma Covered by Cigna in New York Cigna requires prior authorization for Zolgensma (onasemnogene abeparvovec) with strict criteria: genetic confirmation of bi-allelic SMN1 mutations, age under 2 years, recent labs, and anti-AAV9 antibody titer ≤1:50. Submit through Cigna's provider portal or Accredo specialty pharmacy.

How to Get Jaypirca (pirtobrutinib) Covered by Blue Cross Blue Shield in New York: Complete Guide to Prior Authorization, Appeals, and State Resources

Answer Box: Getting Jaypirca (pirtobrutinib) Covered in New York Blue Cross Blue Shield of New York requires prior authorization for Jaypirca (pirtobrutinib) through their specialty pharmacy network. Start by having your oncologist submit a PA request via Availity Essentials portal with documentation of relapsed/refractory mantle cell lymphoma (MCL) or

How to Get Taltz (Ixekizumab) Covered by Aetna CVS Health in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Taltz Covered by Aetna CVS Health in New York Aetna CVS Health requires prior authorization for Taltz (ixekizumab) with step therapy requirements, TB screening, and specialist prescription. The fastest path: (1) Complete the Taltz precertification form with documented moderate-to-severe psoriasis (BSA >3% or PASI score), prior

Work With Your Doctor to Get Trikafta Approved by Cigna in New York: Complete PA Guide and Appeal Process

Answer Box: Getting Trikafta Approved by Cigna in New York Cigna requires prior authorization for Trikafta (elexacaftor/tezacaftor/ivacaftor) in New York. Your CF specialist must submit genetic testing showing F508del or responsive CFTR mutation, diagnosis confirmation (ICD-10 E84.0), and medical necessity documentation. Submit electronically via CoverMyMeds for fastest

How to Get Elevidys Gene Therapy Covered by Aetna CVS Health in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Started To get Elevidys (delandistrogene moxeparvovec-rokl) covered by Aetna CVS Health in New York: Submit prior authorization through the Availity portal with genetic confirmation, ambulatory status documentation, and approved infusion center verification. If denied, file internal appeal within 180 days, then New York external appeal within 4

How to Get Crysvita (Burosumab) Covered by Humana in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Crysvita (Burosumab) Covered by Humana in New York Crysvita (burosumab) requires prior authorization from Humana Medicare Advantage plans. To get approval: (1) Confirm your diagnosis of X-linked hypophosphatemia (XLH) with low serum phosphorus (<2.5-3.0 mg/dL) and PHEX gene testing, (2) Document failure or

How to Get Qalsody (Tofersen) Covered by Humana in New York: Appeals Guide with Forms and Timelines

Answer Box: Getting Qalsody Covered by Humana in New York Qalsody (tofersen) requires prior authorization from Humana for SOD1-mutated ALS patients. If denied, you have 65 days to appeal internally, then 4 months for New York's external review. Key requirements: confirmed SOD1 mutation, neurologist prescription, baseline ALSFRS-R score,

Advate (Octocog Alfa) Approval with Blue Cross Blue Shield in New York: Answers to the Most Common Questions

Answer Box: Getting Advate Covered by Blue Cross Blue Shield in New York Yes, Blue Cross Blue Shield covers Advate (octocog alfa) for hemophilia A in New York, but prior authorization is required. Your hematologist must submit PA documentation including Factor VIII levels, inhibitor testing, and clinical justification. If denied,