Topic

New York

A collection of 425 issues

How to Get Evkeeza (evinacumab-dgnb) Covered by Cigna in New York: Complete Coding & Prior Authorization Guide

Answer Box: Getting Evkeeza Covered by Cigna in New York Evkeeza (evinacumab-dgnb) requires prior authorization from Cigna for homozygous familial hypercholesterolemia (HoFH). Key steps: 1) Confirm HoFH diagnosis with genetic testing or clinical criteria, 2) Document failed trials of maximum statin, ezetimibe, and PCSK9 inhibitor therapy, 3) Submit complete prior

How to Get Firdapse (Amifampridine) Covered by Blue Cross Blue Shield in New York: Forms, Appeals, and Success Strategies

Answer Box: Getting Firdapse Covered in New York Eligibility: Firdapse (amifampridine) requires prior authorization from Blue Cross Blue Shield plans in New York for patients with confirmed Lambert-Eaton myasthenic syndrome (LEMS). Fastest Path: Contact your BCBS member services to obtain the current prior authorization form, have your neurologist complete clinical

How to Get Tagrisso (Osimertinib) Covered by Humana in New York: Prior Authorization Guide and Appeals Process

Answer Box: Getting Tagrisso Covered by Humana in New York Tagrisso (osimertinib) requires prior authorization from Humana before coverage. To get approved: (1) Your doctor submits a PA request with EGFR mutation testing results and clinical documentation through Humana's provider portal, (2) Humana reviews within 7-30 days, and

Work With Your Doctor to Get Tegsedi (inotersen) Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tegsedi Covered by Blue Cross Blue Shield in New York Eligibility: Tegsedi (inotersen) requires prior authorization from Blue Cross Blue Shield for hATTR polyneuropathy in adults. You must be enrolled in the REMS program with regular lab monitoring. Fastest Path: Work with your neurologist to submit complete

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

Answer Box: Getting Evrysdi Covered by Cigna in New York Eligibility: Cigna covers Evrysdi (risdiplam) for spinal muscular atrophy with prior authorization requiring genetic confirmation (SMN1 gene variants), baseline motor function assessment, and neurologist prescription. Fastest approval path: Submit complete PA packet through CoverMyMeds with genetic test results, motor function

How to Get Synagis (Palivizumab) Covered by Humana in New York: Complete PA Guide and Appeals Process

Answer Box: Getting Synagis Covered by Humana in New York Synagis (palivizumab) requires prior authorization from Humana for high-risk infants meeting AAP criteria. Your child must be ≤35 weeks gestational age, have chronic lung disease requiring therapy, or hemodynamically significant congenital heart disease. Submit the PA request through your pediatrician

How Long Does It Take to Get Vanflyta (Quizartinib) Approved by Aetna (CVS Health) in New York? Complete Timeline & Appeals Guide

Answer Box: Getting Vanflyta Covered by Aetna (CVS Health) in New York Standard approval timeline: 30-45 days for prior authorization, with expedited review available in 72 hours for urgent cancer treatment. Aetna requires FLT3-ITD mutation testing, baseline EKG showing QTc ≤450ms, and AML diagnosis confirmation. If denied, New York residents

How to Get Helixate (rFVIII) Covered by Aetna CVS Health in New York: Complete Prior Authorization Guide

Answer Box: Getting Helixate Covered by Aetna CVS Health in New York Important Update: Helixate has been discontinued in the US. You'll need prior authorization for alternative rFVIII products like Kovaltry, Advate, or Jivi through Aetna CVS Health. Submit the Medical Exception/Prior Authorization form with hemophilia A

How to Get Somatuline Depot (Lanreotide) Covered by Cigna in New York: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Somatuline Depot Covered by Cigna in New York Eligibility: Somatuline Depot requires prior authorization from Cigna for acromegaly, gastroenteropancreatic neuroendocrine tumors (GEP-NET), and carcinoid syndrome. Fastest approval path: Have your endocrinologist or oncologist submit a complete PA request through Express Scripts' electronic system with documented octreotide

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Aetna CVS Health in New York: Prior Authorization Guide and Appeals Process

Quick Answer: Getting Enhertu Covered by Aetna in New York Getting Enhertu (fam-trastuzumab deruxtecan-nxki) approved by Aetna CVS Health requires prior authorization for all plans. Call (866) 752-7021 or fax (888) 267-3277 to start. You'll need HER2 pathology reports, prior therapy documentation, and a medical necessity letter with