Topic

New York

A collection of 426 issues

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

How to Get Bavencio (Avelumab) Covered by Humana in New York: Prior Authorization, Appeals & Cost-Saving Strategies

Quick Answer: Getting Bavencio Covered by Humana in New York Bavencio (avelumab) requires prior authorization for all Humana plans in New York. Your oncologist must submit documentation proving you have FDA-approved metastatic Merkel cell carcinoma or maintenance urothelial carcinoma through Humana's provider portal. If denied, you have 60-65

Renewing Approval for Gilenya (Fingolimod) with Blue Cross Blue Shield in New York: Complete Guide to Timeline, Documentation, and Appeals

Quick Answer: Gilenya Renewal with Blue Cross Blue Shield in New York Renewal Timeline: Start 60-90 days before current authorization expires. Required Documentation: Updated medical necessity letter, current monitoring results (EKG, eye exam, liver function), and treatment response data. First Step Today: Contact your neurologist's office to schedule

How to Get Amondys 45 (Casimersen) Covered by Aetna CVS Health in New York: Complete Guide with Forms, Timelines, and Appeal Strategies

Answer Box: Fast Track to Amondys 45 Coverage Aetna CVS Health requires prior authorization for Amondys 45 (casimersen) in New York. The fastest path: (1) Confirm genetic testing shows exon 45-skippable DMD mutation, (2) Have your neuromuscular specialist complete Aetna's precertification form, and (3) Submit via provider portal

How to Get Elelyso (taliglucerase alfa) Covered by Blue Cross Blue Shield in New York: Complete Guide to Prior Authorization, Appeals, and Medical Necessity

Quick Answer: Getting Elelyso Covered in New York Empire BlueCross BlueShield requires prior authorization for Elelyso (taliglucerase alfa). You'll need confirmed Type 1 Gaucher disease diagnosis (enzyme assay or genetic testing), specialist prescriber, and documented failure/intolerance of preferred ERTs like Cerezyme or VPRIV due to step therapy

How to Get Tracleer (bosentan) Covered by Blue Cross Blue Shield in New York: Forms, Appeals & Contact Directory

Answer Box: Getting Tracleer Covered by BCBS New York Blue Cross Blue Shield New York requires prior authorization for Tracleer (bosentan) with mandatory REMS enrollment and specialty pharmacy dispensing. The fastest path: 1) Ensure your cardiologist/pulmonologist and you are enrolled in the Tracleer REMS program, 2) Complete baseline liver

How to Get Exondys 51 (Eteplirsen) Covered by Humana in New York: Complete Guide to Prior Authorization, Appeals & Forms

Quick Answer: Getting Exondys 51 Covered by Humana in New York Eligibility: Patients with Duchenne muscular dystrophy (DMD) and confirmed genetic mutation amenable to exon 51 skipping can get Exondys 51 covered through Humana Medicare Advantage or commercial plans in New York. Fastest path: Submit prior authorization with complete genetic

How to Get Opfolda (miglustat) Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization Guide with Appeals Process

Answer Box: Getting Opfolda Covered by Blue Cross Blue Shield in New York Eligibility: Adults with late-onset Pompe disease (≥40 kg) not improving on current enzyme replacement therapy. Fastest Path: Have your specialist submit prior authorization with ERT failure documentation through Blue Cross provider portal. First Step Today: Contact your

How to Get Brensocatib (BRINSUPRI) Covered by Aetna CVS Health in New York: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Brensocatib Covered by Aetna CVS Health in New York Brensocatib (BRINSUPRI) requires prior authorization from Aetna CVS Health with strict step therapy requirements: documented trial and failure of a macrolide antibiotic and airway clearance therapy. In New York, you have strong appeal rights through the state'

How to Get Strimvelis Gene Therapy Covered by Cigna in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Strimvelis Covered by Cigna in New York Strimvelis requires prior authorization from Cigna as a non-formulary, investigational gene therapy available only at SR-TIGET in Milan, Italy. The fastest path to approval involves: (1) confirming your plan covers international/out-of-network care, (2) submitting Cigna's Commercial Drug