Topic

New York

A collection of 496 issues

Do You Qualify for Ocrevus (Ocrelizumab) Coverage by Cigna in New York? Complete Decision Tree & Appeals Guide

Answer Box: Ocrevus Coverage by Cigna in New York Yes, you likely qualify if you have confirmed relapsing or primary progressive MS and have tried/failed at least one disease-modifying therapy. Cigna requires prior authorization through CoverMyMeds or fax (855-840-1678) with 5-day processing. First step today: Contact your neurologist to

How to Get Dojolvi (triheptanoin) Covered by Humana in New York: Complete Prior Authorization Guide with Appeals Process

Answer Box: Getting Dojolvi Covered by Humana in New York Humana requires prior authorization for Dojolvi (triheptanoin) with molecular confirmation of LC-FAOD diagnosis, specialist prescription, and discontinuation of other MCT products. For New York Medicare Advantage patients, use Medicare's appeal process (not state external appeals). First step today:

How to Get Myozyme (Alglucosidase Alfa) Covered by Cigna in New York: Complete PA Guide and Appeals Process

Answer Box: Getting Myozyme Covered by Cigna in New York Myozyme (alglucosidase alfa) requires prior authorization from Cigna for Pompe disease coverage in New York. Your specialist must submit documentation confirming GAA enzyme deficiency or genetic testing, along with weight-based dosing calculations. Submit via CoverMyMeds or fax to 855-840-1678. If

How to Get Chenodal (Chenodiol) Covered by Humana in New York: Complete Prior Authorization Guide

Answer Box: Getting Chenodal (Chenodiol) Covered by Humana in New York Chenodal (chenodiol) requires prior authorization from Humana for radiolucent gallstones in surgical non-candidates. The fastest path to approval: 1) Gather imaging confirming radiolucent stones and well-opacifying gallbladder, 2) Document 6-month ursodiol trial failure or contraindication, 3) Submit PA via

How to Get Takhzyro (lanadelumab-flyo) Covered by Aetna (CVS Health) in New York: Appeals Guide and State Protections

Answer Box: Quick Path to Coverage Getting Takhzyro (lanadelumab-flyo) covered by Aetna (CVS Health) in New York requires prior authorization and meeting specific HAE criteria. Start with your doctor submitting a PA request through CVS Caremark's provider portal, including confirmed HAE type I/II diagnosis (C4/C1-INH labs)

Trikafta Coverage with Blue Cross Blue Shield in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Trikafta Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield requires prior authorization for Trikafta (elexacaftor/tezacaftor/ivacaftor) in New York. Your CF specialist must submit documentation including CFTR genotype results, baseline labs, and clinical justification. If denied, you have 180 days for

How Long Does It Take to Get Somatuline Depot (Lanreotide) Approved by Aetna CVS Health in New York? Complete Timeline Guide

Answer Box: Getting Somatuline Depot Approved by Aetna CVS Health in New York Aetna CVS Health requires prior authorization for Somatuline Depot (lanreotide) with typical processing taking 2-45 days depending on submission method and completeness. Electronic submissions via Availity process fastest (24-72 hours), while standard requests take 30-45 days. First

How to Get Keytruda (Pembrolizumab) Covered by Humana in New York: Complete PA Guide and Appeal Scripts

Answer Box: Getting Keytruda (Pembrolizumab) Covered by Humana in New York Humana Medicare Advantage plans require prior authorization (PA) for Keytruda, covering it as a Part B medical benefit at 80% after deductible. You'll need FDA-approved biomarker testing (PD-L1, MSI-H, or TMB-H), staging documentation, and medical necessity letters.

How to Get Lutathera (lutetium Lu-177 dotatate) Covered by UnitedHealthcare in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Your Fastest Path to Lutathera Coverage Lutathera requires prior authorization from UnitedHealthcare OptumRx for somatostatin receptor-positive GEP-NETs. Submit PA through the UHC Provider Portal with SSTR-positive imaging (Ga-68 DOTATATE PET), documented progression on somatostatin analogs, and NCCN guideline support. If denied, file internal appeal within 180 days, then

How to Get Elzonris (tagraxofusp-erzs) Covered by Blue Cross Blue Shield in New York: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Elzonris Covered in New York Elzonris (tagraxofusp-erzs) requires prior authorization from Blue Cross Blue Shield for BPDCN treatment. New York patients need: confirmed BPDCN diagnosis with CD123-positive pathology, serum albumin ≥3.2 g/dL, and a capillary leak syndrome monitoring plan. If denied, you have 4 months