Topic

New York

A collection of 443 issues

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

Blue Cross Blue Shield's Coverage Criteria for Elfabrio in New York: What Counts as "Medically Necessary"?

Answer Box: Getting Elfabrio Covered by Blue Cross Blue Shield in New York Elfabrio requires prior authorization from Blue Cross Blue Shield in New York, but no step therapy as of 2024. To qualify: (1) Confirmed Fabry disease diagnosis via genetic testing or enzyme assay, (2) Prescription from a specialist

How to Get Kalydeco (ivacaftor) Covered by Aetna CVS Health in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Get Kalydeco Covered by Aetna CVS Health in New York Aetna CVS Health requires prior authorization for Kalydeco (ivacaftor) based on confirmed CFTR mutation testing and specialist oversight. To get approved in New York: 1. Confirm eligibility: Document responsive CFTR mutation (G551D, R117H, or other FDA-approved variants) with

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

Quick Answer: Getting Elevidys Covered by UnitedHealthcare in New York Elevidys (delandistrogene moxeparvovec-rokl) requires prior authorization from UnitedHealthcare in New York. The fastest path: (1) Ensure anti-AAVrh74 antibody titers are <1:400, (2) Document corticosteroid failure/intolerance, (3) Submit through an approved treatment center via the UnitedHealthcare Provider Portal.

Getting Gilenya (Fingolimod) Covered by Humana in New York: Prior Authorization, Appeals, and State Protections

Answer Box: Fast Track to Gilenya Coverage Getting Gilenya (fingolimod) covered by Humana in New York requires prior authorization with cardiac monitoring documentation and may involve step therapy. Your fastest path: (1) Have your neurologist submit a PA request with baseline EKG, first-dose monitoring plan, and MS diagnosis confirmation via

Get Mavenclad (Cladribine) Approved by Aetna CVS Health in New York: Complete Coverage Guide

Answer Box: Fast Track to Mavenclad Coverage Mavenclad requires prior authorization from Aetna CVS Health in New York. Your fastest path: (1) Confirm relapsing MS diagnosis and document at least two failed disease-modifying therapies, (2) Have your neurologist submit a medical necessity letter with lab results showing lymphocyte count ≥800

How to Get Qinlock (Ripretinib) Covered by Humana in New York: Complete Appeals Guide

Answer Box: Getting Qinlock (Ripretinib) Covered by Humana in New York Qinlock (ripretinib) requires prior authorization from Humana for fourth-line GIST treatment after imatinib, sunitinib, and regorafenib failure. First step: Have your oncologist submit a PA request through Humana's provider portal with complete treatment history and NCCN guideline

How to Get Xyrem (Sodium Oxybate) Covered by UnitedHealthcare in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Xyrem Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization and step therapy for Xyrem (sodium oxybate) in New York. The fastest path to approval: (1) Complete REMS enrollment for both prescriber and patient at XywavXyremREMS.com, (2) Document failed trials of modafinil or armodafinil, and