Topic

New York

A collection of 237 issues

How to Get Alprolix (Factor IX) Covered by Cigna in New York: PA Requirements, Appeals Process, and State Protections

Answer Box: Getting Alprolix Covered by Cigna in New York Cigna typically requires prior authorization (PA) for Alprolix through Express Scripts/Accredo, with decisions within 24-72 hours under New York law. If denied, you have 180 days to file internal appeals, followed by New York's external review process

Getting Zolgensma Covered by Aetna CVS Health in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered in New York Aetna CVS Health requires strict prior authorization for Zolgensma in New York. Your child must be under 2 years old with confirmed SMN1 mutations and anti-AAV9 antibody titers ≤1:50. First step: Have your SMA specialist gather genetic test results and submit

How to Get Qalsody (Tofersen) Covered by Cigna in New York: Complete Appeals Guide with Templates

Answer Box: Getting Qalsody (Tofersen) Covered by Cigna in New York Qalsody (tofersen) requires prior authorization from Cigna, with documented SOD1 mutation and step therapy completion. If denied, you have 180 days for internal appeals and 4 months for New York's external review through the Department of Financial

How to Get Acthar Gel Covered by Cigna in New York: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Acthar Gel Covered by Cigna in New York Cigna requires prior authorization for Acthar Gel (repository corticotropin injection) with documented failure or contraindication to corticosteroids for approved indications like infantile spasms and MS exacerbations. Submit your PA request through CoverMyMeds or fax Cigna's current PA

Myths vs. Facts: Getting Luxturna (Voretigene Neparvovec-rzyl) Covered by Cigna in New York

Answer Box: Fast Track to Luxturna Coverage Myth-busting reality: Cigna covers Luxturna in New York, but requires prior authorization with genetic testing proving biallelic RPE65 mutations and retinal viability documentation. Most denials stem from incomplete paperwork, not medical necessity. Your fastest path: Submit complete PA with CLIA-certified genetic results through

How to Get StrataGraft Approved by Cigna in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting StrataGraft Covered by Cigna in New York StrataGraft requires prior authorization under Cigna's medical benefit (not pharmacy) in New York. The fastest path to approval: 1) Confirm your provider is in-network, 2) Submit Cigna's tissue-engineered skin substitute PA form with complete burn documentation

Myths vs. Facts: Getting Zokinvy (lonafarnib) Covered by Cigna in New York

Answer Box: Zokinvy Coverage by Cigna in New York Eligibility: Patients ≥12 months with confirmed HGPS (genetic testing required) and BSA ≥0.39 m². Fastest path: Submit prior authorization through Cigna's specialty pharmacy (typically Accredo) with complete genetic documentation and specialist prescription. First step today: Contact your geneticist

Myths vs. Facts: Getting Natpara (Parathyroid Hormone) Covered by UnitedHealthcare in New York

Answer Box: The Reality of Natpara Coverage in New York Myth-Busting Summary: Natpara (parathyroid hormone) is being discontinued by Takeda, with all U.S. shipments ending December 31, 2025. UnitedHealthcare is not approving new patients for Natpara, only maintaining existing Special Use Program enrollees. New York residents facing denials should

How to Get Epidiolex (Cannabidiol) Covered by Aetna CVS Health in New York: Complete Guide with Appeals Process

Quick Answer: Getting Epidiolex Covered by Aetna CVS Health in New York Aetna CVS Health requires prior authorization for Epidiolex (cannabidiol) in New York for patients with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex. The fastest path: have your prescriber submit a PA request with diagnosis confirmation and prior

How to Get Imbruvica (Ibrutinib) Approved by Humana in New York: Timeline, Appeals, and Documentation Guide

Answer Box: Getting Imbruvica Covered by Humana in New York Fastest path to approval: Humana typically requires prior authorization for Imbruvica (ibrutinib), with decisions within 7 days for standard requests or 72 hours for expedited reviews. Your prescriber must submit pathology reports confirming CLL/SLL/Waldenström macroglobulinemia, flow cytometry results,