Topic

New York

A collection of 427 issues

Do You Qualify for Crysvita (Burosumab) Coverage by Aetna CVS Health in New York? Decision Tree & Next Steps

Quick Answer: To get Crysvita (burosumab) covered by Aetna CVS Health in New York, you need genetic confirmation of XLH or biochemical proof of TIO, documented failure of conventional therapy, and submission through CVS Specialty at 1-866-814-5506. Most approvals take 30-45 days with complete documentation. If denied, file an internal

How to Get Galafold (migalastat) Approved by Cigna in New York: Complete Timeline and Appeal Guide

Answer Box: Getting Galafold Approved by Cigna in New York Eligibility: Adults with Fabry disease and a confirmed amenable GLA variant. Fastest path: Submit prior authorization with genetic testing proof of amenable variant, specialist prescription, and medical necessity letter through Cigna's ePA portal. Timeline: 5-15 business days for

How to Get Hemlibra (emicizumab-kxwh) Covered by Aetna (CVS Health) in New York: Complete PA Guide and Appeals Process

Answer Box: Getting Hemlibra Covered by Aetna (CVS Health) in New York Hemlibra (emicizumab-kxwh) requires prior authorization from Aetna (CVS Health) in New York. The fastest path to approval: 1) Work with a hematologist to document hemophilia A diagnosis and factor VIII inhibitor status or treatment failures, 2) Submit comprehensive

Besponsa (Inotuzumab Ozogamicin) Approval with Aetna CVS Health in New York: Complete Guide to Prior Authorization, Appeals, and State Protections

Answer Box: Getting Besponsa Covered by Aetna CVS Health in New York Yes, Aetna CVS Health covers Besponsa (inotuzumab ozogamicin) in New York with prior authorization for CD22-positive B-cell precursor ALL. The fastest path to approval: (1) Your oncologist submits the Aetna Besponsa precertification form electronically with CD22+ lab results

Taltz (ixekizumab) Approval with UnitedHealthcare in New York: Complete Guide with Forms, Appeals, and Patient Scripts

Quick Answer: Getting Taltz (ixekizumab) Covered by UnitedHealthcare in New York Yes, UnitedHealthcare covers Taltz (ixekizumab) in New York, but requires prior authorization with documented step therapy failure. You must first try preferred biologics like Humira or Enbrel, plus complete TB screening. Fastest path: Have your dermatologist or rheumatologist submit

How to Get Strensiq (Asfotase Alfa) Covered by Cigna in New York: Complete PA Guide and Appeals Strategy

Answer Box: Getting Strensiq Covered by Cigna in New York Eligibility: Cigna covers Strensiq (asfotase alfa) for pediatric-onset hypophosphatasia (HPP) only—perinatal, infantile, or juvenile onset before age 18. Required documentation: ALPL gene mutation, low alkaline phosphatase levels, and specialist prescription. First step: Contact your pediatric endocrinologist or geneticist to

How to Get Soliris (Eculizumab) Covered by Cigna in New York: Complete Timeline and Appeal Guide

Answer Box: Getting Soliris Covered by Cigna in New York Getting Soliris (eculizumab) covered by Cigna in New York requires prior authorization with a 5-day standard review timeline. The fastest path: (1) Complete Cigna's Soliris PA form with all required documentation—FDA-approved diagnosis, meningococcal vaccination records, and REMS

Work With Your Doctor to Get Tracleer (Bosentan) Approved by UnitedHealthcare in New York: Complete Provider Partnership Guide

Answer Box: Your Fastest Path to Approval To get Tracleer (bosentan) covered by UnitedHealthcare in New York, you'll need: specialist prescribing, REMS program enrollment, documented WHO Group 1 PAH diagnosis via right heart catheterization, and evidence of failed step therapy. Start today by: scheduling with your pulmonologist or

How to Get Pemazyre (Pemigatinib) Covered by Humana in New York: Complete Forms, Appeals, and Support Guide

Quick Answer: Getting Pemazyre Covered by Humana in New York Pemazyre (pemigatinib) requires prior authorization from Humana in New York. Key requirements: FGFR2 fusion testing report, baseline eye exam, and treatment history documentation. Submit via Humana's provider portal or fax to 877-486-2621. Standard approval takes 7 days; expedited

How to Get Zolgensma Covered by UnitedHealthcare in New York: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Zolgensma Covered by UnitedHealthcare in New York Fastest Path to Approval: UnitedHealthcare requires prior authorization for Zolgensma with genetic confirmation, anti-AAV9 antibody testing (≤1:50), and documentation of failed alternative therapies or contraindications. Submit through OptumRx with complete medical records. If denied, file internal appeal within 180