Topic

New York

A collection of 427 issues

How to Get Xembify (Immune Globulin) Covered by Humana in New York: Appeals, Forms, and State Protections

Answer Box: Getting Xembify Covered by Humana in New York Xembify (immune globulin, SC) requires prior authorization from Humana Medicare plans in New York. Your fastest path to approval: have your provider submit a complete PA request with primary immunodeficiency diagnosis, quantitative immunoglobulin levels, infection history, and documentation of failed

How to Get Tremfya (Guselkumab) Covered by Cigna in New York: Complete Prior Authorization Guide

Quick Answer: Getting Tremfya Covered by Cigna in New York Eligibility: Tremfya requires prior authorization through Cigna for adults with moderate-to-severe plaque psoriasis, psoriatic arthritis, or Crohn's disease. Fastest path: Have your specialist submit a complete prior authorization with documented disease severity (PASI ≥10 for psoriasis), prior therapy

How to Get Ocrevus (ocrelizumab) Covered by Humana in New York: Prior Authorization Guide and Appeal Process

Quick Answer: Getting Ocrevus Covered by Humana in New York Ocrevus (ocrelizumab) requires prior authorization from Humana and is typically covered under Medicare Part B when administered as an infusion. The fastest path to approval: (1) Ensure your neurologist documents confirmed MS diagnosis using McDonald criteria with supporting MRI evidence,

The Complete Guide to Getting Sumavel DosePro Covered by Aetna (CVS Health) in New York: Forms, Appeals, and Approval Strategies

Answer Box: Fast Track to Coverage Who qualifies: Adults with migraine or cluster headache who've failed at least two oral triptans. Fastest approval path: Submit Aetna's prior authorization form with documented step therapy failures, clinical notes showing medical necessity, and correct ICD-10 codes (G43.x for

How to Get Ibrance (Palbociclib) Approved by Aetna CVS Health in New York: Timeline, Appeals, and Authorization Guide

Answer Box: Getting Ibrance Covered by Aetna CVS Health in New York Aetna CVS Health requires prior authorization for Ibrance (palbociclib) with step therapy requirements. The fastest approval path: submit complete documentation showing HR+/HER2- breast cancer diagnosis, prior endocrine therapy failure, and combination partner (aromatase inhibitor or fulvestrant). Standard

Renewing Palynziq (pegvaliase-pqpz) Approval with Cigna in New York: 2025 Requirements, Timelines & Appeal Options

Answer Box: Renewing Palynziq Coverage with Cigna in New York To renew Palynziq (pegvaliase-pqpz) with Cigna in New York, submit renewal documentation 60 days before your current authorization expires. Required: recent phenylalanine levels showing ≥20% reduction from baseline or levels ≤600 µmol/L, continued REMS enrollment, and metabolic specialist attestation.

Do You Qualify for Vyndaqel/Vyndamax Coverage by UnitedHealthcare in New York? Complete Decision Tree & Appeal Guide

Answer Box: Getting Vyndaqel/Vyndamax Covered by UnitedHealthcare in New York Quick answer: UnitedHealthcare requires prior authorization for tafamidis (Vyndaqel/Vyndamax) in New York with confirmed ATTR-CM diagnosis, NYHA Class I-III heart failure, and cardiology oversight. First step today: Gather your PYP scan results, AL amyloidosis exclusion labs, and current

How to Get Ultomiris (Ravulizumab) Covered by Humana in New York: Coding, Appeals, and Prior Authorization Guide

Answer Box: Getting Ultomiris Covered by Humana in New York Ultomiris (ravulizumab) requires prior authorization from Humana Medicare Advantage plans in New York. The fastest path to approval involves proper medical coding (ICD-10: D59.5 for PNH, HCPCS: J1303 for billing), comprehensive clinical documentation, and understanding New York's

If Waylivra (Volanesorsen) Isn't Approved by UnitedHealthcare in New York: Formulary Alternatives & Exception Paths

Answer Box: Waylivra Coverage Through UnitedHealthcare in New York Waylivra (volanesorsen) is not FDA-approved in the US and not covered by UnitedHealthcare's 2025 formularies. However, New York patients have strong appeal rights with a 57% external review success rate. First step: Request FDA-approved Tryngolza (olezarsen) as the preferred

How to Get Symdeko/Symkevi (Tezacaftor/Ivacaftor) Covered by Cigna in New York: Complete Timeline & Appeals Guide

Quick Answer: Getting Symdeko/Symkevi Covered by Cigna in New York Symdeko/Symkevi requires prior authorization from Cigna, typically taking 1-3 weeks with complete documentation. The fastest path: (1) Have your CF specialist submit genetic testing results proving F508del or qualifying mutations, (2) Include a detailed medical necessity letter, and