Topic

New York

A collection of 433 issues

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

How to Get Vyndaqel / Vyndamax (Tafamidis) Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization Guide

Quick Answer: Getting Vyndaqel/Vyndamax Approved by BCBS in New York Blue Cross Blue Shield typically covers tafamidis (Vyndaqel/Vyndamax) for ATTR-CM with prior authorization. You'll need confirmed diagnosis, cardiology oversight, and documentation of appropriate heart failure class. If denied, New York offers strong external appeal rights through

Getting Soliris (Eculizumab) Approved by Humana in New York: Complete Coding and Appeal Guide

Quick Answer: Your Path to Approval Soliris (eculizumab) is covered under Humana Medicare Part B when medically necessary for FDA-approved conditions. Key requirements: proper ICD-10 diagnosis coding, proof of meningococcal vaccination, and specialist documentation. Start today: Have your provider submit a prior authorization using HCPCS code J1299 (2 mg/unit)

Getting Aldurazyme (Laronidase) Covered by UnitedHealthcare in New York: Complete Coding and Appeals Guide

Answer Box: Getting Aldurazyme Covered by UnitedHealthcare in New York Aldurazyme (laronidase) requires prior authorization from UnitedHealthcare for mucopolysaccharidosis I (MPS I) treatment. Three-step fast track: 1) Gather genetic/enzymatic confirmation of MPS I diagnosis with ICD-10 codes E76.01-E76.03, 2) Submit PA using HCPCS J1931 with precise dosing

Renewing Tremfya (Guselkumab) Coverage with Humana in New York: 2025 Requirements and Timeline

Answer Box: To renew Tremfya (guselkumab) coverage with Humana in New York, submit your renewal request with updated clinical documentation 30-60 days before your current authorization expires. Include PASI scores showing continued response, adherence documentation, and any new clinical notes. Humana reviews renewals within 72 hours (standard) or 24 hours

Get Defitelio (Defibrotide) Covered by Aetna CVS Health in New York: Prior Authorization Guide & Appeals Process

Answer Box: Getting Defitelio Covered by Aetna CVS Health in New York Defitelio (defibrotide) requires prior authorization from Aetna CVS Health for hepatic veno-occlusive disease (VOD)/sinusoidal obstruction syndrome (SOS) with organ dysfunction post-transplant. Key requirements: documented VOD/SOS diagnosis using Baltimore or Cairo criteria, evidence of renal or pulmonary

How to Get Mavenclad (Cladribine Tablets) Covered by Cigna in New York: A Complete Prior Authorization and Appeals Guide

Answer Box: Getting Mavenclad Covered by Cigna in New York Cigna requires prior authorization for Mavenclad (cladribine tablets) with strict step therapy requirements. You must document failure/intolerance of two other MS therapies OR one high-efficacy agent (Ocrevus, Tysabri, Kesimpta, Lemtrada, or Briumvi). Your neurologist submits the PA through Cigna&

Do You Qualify for Xywav Coverage by UnitedHealthcare in New York? Decision Tree & Appeals Guide

Quick Answer: Getting Xywav Covered by UnitedHealthcare in New York Eligibility: You likely qualify if you have narcolepsy (type 1 or 2) or idiopathic hypersomnia with documented sleep study results, are enrolled in the REMS program, and have tried required step therapy medications. Fastest path: Submit prior authorization through OptumRx