Topic

New York

A collection of 440 issues

How to Get Besponsa Covered by UnitedHealthcare in New York: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Besponsa Covered by UnitedHealthcare in New York Besponsa (inotuzumab ozogamicin) requires prior authorization from UnitedHealthcare for all commercial and Medicare plans. Your oncologist must document CD22-positive B-cell ALL, failed first-line therapy, and hepatic monitoring plans. If denied, you have 180 days for internal appeals and 4 months

Myths vs. Facts: Getting Signifor / Signifor LAR (pasireotide) Covered by Cigna in New York

Answer Box: Getting Signifor / Signifor LAR Covered by Cigna in New York Eligibility: Cigna requires prior authorization for Signifor / Signifor LAR with strict criteria: confirmed Cushing's disease or acromegaly, endocrinologist prescription, documented failure of first-generation somatostatin analogs (for acromegaly), and surgical ineligibility or post-surgical persistence. Fastest path: Submit

The Complete Checklist to Get Krystexxa (Pegloticase) Covered by Humana in New York

Answer Box: Getting Krystexxa Covered by Humana in New York Eligibility: Patients with chronic gout refractory to allopurinol and febuxostat who have G6PD testing completed and serum uric acid >6 mg/dL. Fastest Path: Submit prior authorization through Humana's provider portal with medical necessity letter documenting failed

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

Answer Box: Getting Procysbi Covered in New York To get Procysbi (cysteamine bitartrate DR) covered by Blue Cross Blue Shield in New York: Your doctor must submit a prior authorization request with nephropathic cystinosis diagnosis confirmation (elevated WBC cystine levels), documentation of medical necessity, and evidence of step therapy completion

How to Get Xembify Covered by Cigna in New York: A Real Patient's Journey from Denial to Approval

Answer Box: Getting Xembify Covered by Cigna in New York Eligibility: Patients with documented primary immunodeficiency (PID) and low immunoglobulin levels can get Xembify covered by Cigna with proper prior authorization. Fastest Path: 1) Gather PID diagnosis documentation and infection history, 2) Submit Cigna's prior authorization form with

How to Get Alecensa (alectinib) Covered by Aetna CVS Health in New York: Appeals, Forms & Success Strategies

Answer Box: Fast-Track to Alecensa Coverage Getting Alecensa (alectinib) covered by Aetna CVS Health in New York requires prior authorization with ALK testing documentation. The fastest path: (1) Ensure your oncologist submits complete ALK-positive test results with the PA request, (2) Include surgical/treatment history if seeking adjuvant coverage, and

How to Get Alprolix (Factor IX) Covered by Humana in New York: Complete Guide with Forms and Appeal Process

Answer Box: Getting Alprolix Covered by Humana in New York Alprolix (coagulation factor IX) requires prior authorization from Humana Medicare Advantage plans. Your fastest path to approval: (1) Have your hematologist submit a PA request to Humana at 866-461-7273 or fax 888-447-3430 with clinical documentation showing hemophilia B diagnosis and

How to Get Isturisa (Osilodrostat) Covered by UnitedHealthcare in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Isturisa Covered by UnitedHealthcare in New York Eligibility: Adults with Cushing's disease when pituitary surgery isn't an option or hasn't worked. Fastest path: Submit prior authorization through OptumRx with endocrinologist documentation, surgical history, and elevated cortisol labs (UFC, salivary cortisol). First

How to Get Soliris (eculizumab) Covered by Aetna (CVS Health) in New York: Complete Prior Authorization Guide

Answer Box: Get Soliris Covered by Aetna (CVS Health) in New York Aetna (CVS Health) requires prior authorization for Soliris (eculizumab) with strict diagnostic and documentation criteria. Success requires: (1) Complete the Aetna Soliris prior authorization form with disease-specific lab results (flow cytometry for PNH, AChR antibodies for myasthenia gravis,

Getting Elzonris (Tagraxofusp-erzs) Covered by UnitedHealthcare in New York: Complete Decision Tree & Appeals Guide

Answer Box: Quick Qualification Check Most patients with confirmed CD123-positive BPDCN can get Elzonris covered by UnitedHealthcare in New York. The fastest path requires: (1) Updated pathology report confirming CD123+ BPDCN, (2) Capillary leak syndrome monitoring plan documented, (3) Prior authorization submitted through OptumRx with complete clinical records. First step