Topic

New York

A collection of 425 issues

Renewing Mycapssa (Octreotide Oral) Approval with Blue Cross Blue Shield in New York: Complete Timeline and Documentation Guide

Quick Answer: Renewing Your Mycapssa Coverage Mycapssa renewals with Blue Cross Blue Shield in New York require documentation of continued treatment response and no disease progression. Start the renewal process 60-90 days before your current authorization expires. You'll need updated IGF-1 labs, treatment response documentation, and a provider

Myths vs. Facts: Getting Hetlioz LQ (tasimelteon oral suspension) Covered by Blue Cross Blue Shield in New York

Answer Box: Getting Hetlioz LQ covered by Blue Cross Blue Shield in New York requires prior authorization with specific clinical documentation. You'll need confirmed Smith-Magenis syndrome diagnosis with genetic testing, documented failure of melatonin therapy for at least 6 months, and specialist consultation. Submit through Availity Essentials or

How to Get Strensiq (Asfotase Alfa) Covered by UnitedHealthcare in New York: 2025 Renewal Timeline and Appeal Guide

Quick Answer: Getting Strensiq Covered by UnitedHealthcare in New York Strensiq requires prior authorization from UnitedHealthcare through OptumRx. Start renewal 30-60 days before expiration to avoid gaps. Submit complete documentation including genetic confirmation, treatment response data, and specialist attestation. If denied, file internal appeal within 180 days, then external review

How to Get Amvuttra (Vutrisiran) Covered by Aetna CVS Health in New York: Complete PA Guide with Appeals Process

Answer Box: Getting Amvuttra (Vutrisiran) Covered by Aetna CVS Health in New York Fastest path to approval: Submit Aetna's Amvuttra precertification form with genetic testing (for hATTR-PN) or heart failure documentation (for ATTR-CM), plus evidence of contraindications to preferred alternatives like Onpattro or tafamidis. First step today: Verify

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

Answer Box: Getting Myozyme Covered by Aetna CVS Health in New York Fastest Path to Approval: Submit prior authorization through CVS Specialty Pharmacy with confirmed Pompe disease diagnosis (GAA enzyme testing + genetic confirmation), specialist evaluation, and dosing at 20 mg/kg every 2 weeks per FDA label. If denied, file

Oxbryta (Voxelotor) Coverage After FDA Withdrawal: What New York Patients Need to Know About Blue Cross Blue Shield Transitions

Answer Box: Oxbryta Coverage Status in New York Oxbryta (voxelotor) is no longer FDA-approved as of September 2024 due to safety concerns. Blue Cross Blue Shield plans in New York now deny claims for this discontinued medication. If you were taking Oxbryta, immediately contact your healthcare provider to discuss alternative

How Long Does It Take to Get Keytruda (Pembrolizumab) Approved by Blue Cross Blue Shield in New York? Complete Timeline Guide

Answer Box: Keytruda Approval Timeline in New York Getting Keytruda (pembrolizumab) approved by Blue Cross Blue Shield in New York typically takes 15 business days for standard prior authorization, or 72 hours for expedited reviews when medically urgent. Your oncologist must submit biomarker test results (PD-L1, MSI-H, or TMB-H as

Resources to Get Eloctate (Coagulation Factor VIII) Approved with Humana in New York: Forms, Portals & Contacts

Answer Box: Getting Eloctate Covered by Humana in New York Eligibility: Eloctate requires prior authorization through Humana Medicare Advantage plans. Fastest path: Contact your hematologist to submit PA documentation including hemophilia A diagnosis (ICD-10: D66), prior Factor VIII trials, and treatment plan. First step today: Call Humana at 800-867-6601 to

The Complete Requirements Checklist to Get Spinraza (Nusinersen) Covered by Blue Cross Blue Shield in New York

Answer Box: Your Path to Spinraza Coverage Who qualifies: Patients with genetically confirmed 5q SMA (Types 1-3) who haven't received concurrent SMA therapies like Zolgensma or Evrysdi. Fastest approval path: Submit prior authorization with genetic testing results, baseline motor function scores, and neurologist attestation through your Blue Cross

Getting Lutathera Covered by Cigna in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Approval Lutathera (lutetium Lu-177 dotatate) requires prior authorization from Cigna in New York. Your oncologist must document SSTR-positive imaging, well-differentiated neuroendocrine tumor pathology, and progression on somatostatin analog therapy. Standard approval takes 72 hours; expedited review takes 24 hours for urgent cases. If denied, you