Topic

New York

A collection of 42 issues

How Long Does It Take to Get Signifor LAR (Pasireotide) Approved by Humana in New York? Timeline & Appeal Process

Answer Box: Getting Signifor LAR Covered by Humana in New York Timeline: Humana Medicare Advantage must decide on Signifor LAR (pasireotide) prior authorization within 7 calendar days (standard) or 72 hours (expedited) starting January 2026. Currently, most electronic submissions get responses within one business day. Fastest path: Submit complete documentation

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

Answer Box: Getting Synagis Covered by Aetna CVS Health in New York Aetna CVS Health requires prior authorization for Synagis (palivizumab) and only covers it when Beyfortus is contraindicated, not tolerated, or ineffective. Your child must meet strict high-risk criteria: premature infants <29 weeks and <12 months old,

How to Get Thiola / Thiola EC (Tiopronin) Covered by Humana in New York: Appeals, Timelines, and State Protections

Answer Box: Fast Track to Thiola Coverage Getting Thiola/Thiola EC approved by Humana in New York requires three key steps: First, ensure your prescriber documents failed conservative treatments (hydration, alkalinization) and includes a 24-hour urine cystine level showing elevated excretion. Second, if denied, file an internal appeal within 65

Complete Guide: Getting Busulfex (Busulfan Injection) Covered by Aetna in New York - Prior Authorization, Appeals & Forms

Answer Box: Getting Busulfex Covered by Aetna in New York Busulfex (busulfan injection) requires prior authorization from Aetna for transplant conditioning in chronic myeloid leukemia. The fastest path to approval involves three key steps: (1) Confirm your transplant center is an Aetna Institute of Excellence facility, (2) Have your transplant

How to Get Alprolix Covered by Aetna CVS Health in New York: Formulary Status, Appeals Process & PA Requirements

Quick Answer: Getting Alprolix Covered by Aetna CVS Health in New York Challenge: Alprolix is excluded from Aetna's 2024 Advanced Control Formulary, meaning routine prior authorization isn't available. Path forward: Request a coverage exception with strong medical necessity documentation from your hematologist. First step today: Contact

How to Get Nucala (Mepolizumab) Covered by Aetna CVS Health in New York: Complete Guide with Forms and Appeal Process

Answer Box: Getting Nucala Covered by Aetna CVS Health in New York Yes, Nucala (mepolizumab) can be covered by Aetna CVS Health in New York, but requires prior authorization. You'll need a blood eosinophil count ≥150 cells/µL, documented failure of high-dose inhaled steroids plus another controller, and

How to Get Elaprase (Idursulfase) Covered by Humana in New York: Complete Appeals Guide

Answer Box: Get Elaprase Covered by Humana in New York Elaprase (idursulfase) requires prior authorization from Humana Medicare plans. Your fastest path to approval: (1) Have your doctor submit enzymatic/genetic test results confirming Hunter syndrome via Humana's provider portal or fax to 877-486-2621, (2) Include weight-based dosing

Getting Rapivab (Peramivir) Covered by Humana in New York: Coding, Appeals, and Prior Authorization Guide

Answer Box: Getting Rapivab (Peramivir) Covered by Humana in New York Rapivab (peramivir) requires prior authorization from Humana Medicare Advantage plans in New York. Submit requests using HCPCS code J2547, proper ICD-10 codes (J09-J11 series), and documentation showing symptom onset within 48 hours plus inability to use oral antivirals. First

How to Get Fintepla (fenfluramine) Covered by Humana in New York: Complete Guide with Forms and Appeals

Answer Box: Getting Fintepla Covered by Humana in New York Fintepla (fenfluramine) requires prior authorization from Humana for Dravet syndrome and Lennox-Gastaut syndrome patients. The fastest path to approval involves three critical steps: 1) Complete REMS enrollment for both prescriber and patient, 2) Submit baseline echocardiogram showing cardiac safety, and

How to Get Zolgensma Approved by UnitedHealthcare in New York: Complete Prior Authorization Guide

Answer Box: Getting Zolgensma Covered by UnitedHealthcare in New York Zolgensma requires prior authorization from UnitedHealthcare for SMA patients under 2 years old with confirmed SMN1 gene mutations. The fastest path: (1) Submit genetic testing results and clinical documentation through the UHC Provider Portal, (2) Request expedited review if medically