Topic

New York

A collection of 430 issues

How to Get Tysabri (Natalizumab) Covered by Cigna in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tysabri Covered by Cigna in New York Tysabri (natalizumab) requires prior authorization from Cigna and is covered under the medical benefit as a specialty infusion. Key requirements: TOUCH program enrollment for patient, prescriber, and infusion site; documented failure of at least one MS therapy; current MRI and

How to Get Uptravi (Selexipag) Covered by UnitedHealthcare in New York: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Uptravi Covered by UnitedHealthcare in New York Uptravi (selexipag) requires prior authorization from UnitedHealthcare for pulmonary arterial hypertension (PAH) patients in New York. Your fastest path to approval: 1. Confirm WHO Group I PAH diagnosis with right heart catheterization results 2. Document step therapy (failed PDE5 inhibitors

How to Get Rylaze (Asparaginase Erwinia Chrysanthemi) Covered by Cigna in New York: Complete Appeals Guide with State Protections

Answer Box: Getting Rylaze Covered by Cigna in New York Rylaze (asparaginase erwinia chrysanthemi) requires prior authorization from Cigna, with specific documentation of hypersensitivity to E. coli-derived asparaginase. Your fastest path to approval: (1) Gather proof of allergic reaction to Oncaspar/pegaspargase, (2) Have your oncologist complete Cigna's

Get Spinraza (Nusinersen) Covered by Cigna in New York: Complete Prior Authorization and Appeal Guide

Answer Box: Fast Track to Spinraza Coverage Getting Spinraza (nusinersen) covered by Cigna in New York requires prior authorization with genetic confirmation of 5q SMA, specialist prescription, and motor function documentation. Your fastest path: (1) Have your neurologist complete Cigna's Spinraza PA form with genetic test results and

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

Answer Box: Getting Cometriq Covered by Humana in New York Cometriq (cabozantinib) requires prior authorization from Humana Medicare Advantage and Part D plans. Your oncologist must submit documentation proving progressive, metastatic medullary thyroid carcinoma (ICD-10: C73) with evidence the disease isn't surgically curable. Fastest path: Have your oncologist

How to Get Garadacimab (Andembry) Covered by UnitedHealthcare in New York: PA Requirements, Appeals, and Cost-Saving Strategies

Answer Box: Getting Garadacimab Covered by UnitedHealthcare in New York Garadacimab (Andembry) requires prior authorization from UnitedHealthcare's OptumRx with step therapy requirements. You must document failed or contraindicated HAE prophylaxis treatments before approval. First step today: Contact your HAE specialist to gather documentation of prior therapy failures and

Getting Upstaza (Eladocagene Exuparvovec) Covered by Humana in New York: Complete Coverage Guide

Answer Box: Your Path to Upstaza Coverage Humana requires prior authorization for Upstaza (eladocagene exuparvovec) gene therapy in New York. To qualify, you need confirmed AADC deficiency via genetic testing and enzyme assays, treatment at a certified gene therapy center, and comprehensive documentation. If denied, New York's external

How to Get Pemazyre (Pemigatinib) Covered by Blue Cross Blue Shield in New York: Complete Guide with Appeals Process

Quick Answer: Getting Pemazyre Covered in New York Eligibility: Pemazyre (pemigatinib) requires prior authorization from Blue Cross Blue Shield for FGFR2+ cholangiocarcinoma or FGFR1+ myeloid/lymphoid neoplasms after prior therapy failure. Fastest path: Submit PA request with FGFR testing results, prior treatment records, and oncologist letter of medical necessity. Start

Lowering Out-of-Pocket for Voydeya (danicopan) with Cigna in New York: Copay, Tiering & Assistance

Answer Box: Quick Path to Lower Voydeya Costs Voydeya (danicopan) is a Tier 4 specialty drug on Cigna's formulary requiring prior authorization and costing 25-33% coinsurance or high copays. To reduce costs: (1) Apply for Alexion OneSource copay assistance (up to $15,000/year for commercial insurance), (2)

How to Get Orfadin (nitisinone) Covered by Humana in New York: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Orfadin (nitisinone) Covered by Humana in New York Humana requires prior authorization for Orfadin (nitisinone) to treat hereditary tyrosinemia type 1 (HT-1). Your fastest path to approval: Gather confirmed HT-1 diagnosis (elevated succinylacetone levels, genetic testing), obtain a medical necessity letter from your prescriber, and submit through