Topic

New York

A collection of 419 issues

How to Get Arikayce Covered by Blue Cross Blue Shield in New York: Prior Authorization Forms, Appeal Scripts, and External Review

Quick Answer: Getting Arikayce Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield of New York requires prior authorization for Arikayce (amikacin liposome inhalation) for refractory MAC lung disease. Submit PA via Availity Essentials with proof of 6+ months failed combination therapy and positive sputum cultures.

How to Get Koselugo (Selumetinib) Covered by Cigna in New York: Complete Guide with Forms, Appeals, and Timelines

Answer Box: Getting Koselugo (Selumetinib) Covered by Cigna in New York Cigna requires prior authorization for Koselugo (selumetinib) in pediatric patients ≥2 years with NF1-related plexiform neurofibromas. Initial approval lasts 12 months with documented baseline LVEF and ophthalmologic evaluation. First step: Have your oncologist submit PA through Cigna's

How to Get Procysbi (Cysteamine Bitartrate DR) Covered by Aetna CVS Health in New York: Complete Requirements Checklist

Answer Box: Getting Procysbi Covered by Aetna CVS Health in New York Procysbi requires prior authorization through CVS Caremark with documented nephropathic cystinosis diagnosis (ICD-10 E72.04), baseline WBC cystine levels, and typically a trial/failure of immediate-release cysteamine. Submit via CVS Specialty Pharmacy enrollment with complete clinical documentation. If

Work With Your Doctor to Get Haegarda Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization Guide

Answer Box: Getting Haegarda Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield (BCBS) requires prior authorization for Haegarda with confirmed HAE diagnosis (low C4, C1-INH levels), attack history ≥2/month, and specialist prescriber. Fastest approval path: Submit complete PA packet via Availity provider portal with

How Long Does It Take to Get Cerezyme (Imiglucerase) Approved by Humana in New York? Complete Timeline Guide

Answer Box: Getting Cerezyme Approved by Humana in New York Timeline: 2-3 weeks total if all documentation is complete. Humana requires prior authorization with step therapy to Elelyso or Vpriv first, unless medically contraindicated. Fastest path: Have your prescriber submit a complete PA with enzyme/genetic testing, step therapy documentation,

How to Renew Your Gilenya (Fingolimod) Approval with Cigna in New York: Complete Timeline and Checklist

Answer Box: Quick Start for New York Residents Your Gilenya (fingolimod) prior authorization with Cigna typically expires after 12 months and requires renewal with updated clinical documentation. Start the renewal process 60 days before expiration to avoid coverage gaps. First step: Check your PA expiration date in the Cigna member

How to Get iLink® Corneal Cross-Linking Covered by Humana in New York: Prior Authorization Guide and Appeals Strategy

Answer Box: Getting iLink® Covered by Humana in New York Humana covers iLink® corneal cross-linking for progressive keratoconus when medical necessity criteria are met. Prior authorization is required with documented progression (≥1.0D Kmax increase over 12 months on serial topography). If denied, New York residents have strong appeal rights

How to Get Waylivra (Volanesorsen) Covered by Humana in New York: Complete Appeal Guide with Forms and Timelines

Quick Answer: Getting Waylivra Covered by Humana in New York Waylivra (volanesorsen) isn't FDA-approved in the US, making Humana coverage challenging but possible through formulary exceptions and appeals. Start with a prior authorization request using genetic FCS confirmation and triglyceride levels ≥880 mg/dL. If denied, file an

How to Get Cimzia (Certolizumab Pegol) Covered by UnitedHealthcare in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Cimzia Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Cimzia (certolizumab pegol) but approves 85.2% of appeals when properly documented. Key requirements: specialist prescription, TB/hepatitis B screening, and proof of failed conventional therapies. Submit via UHC provider portal with complete medical records.

How to Get Venclexta (venetoclax) Covered by Aetna (CVS Health) in New York: Complete PA Guide and Appeals Process

Answer Box: Get Venclexta (venetoclax) Covered by Aetna (CVS Health) in New York Venclexta requires prior authorization from Aetna (CVS Health) with step therapy requirements (documented BTK inhibitor failure for CLL) and mandatory tumor lysis syndrome prevention plans. Submit via CVS Caremark provider portal with complete medical records, FDA indication