Topic

New York

A collection of 443 issues

Lowering Out-of-Pocket Costs for Revlimid (Lenalidomide) with UnitedHealthcare in New York: Copay Programs, Appeals, and Financial Assistance

Answer Box: Getting Revlimid Covered Affordably in New York Revlimid (lenalidomide) costs can be reduced significantly with UnitedHealthcare in New York through manufacturer copay assistance (commercial plans only), foundation grants, and tier exception appeals. Start by checking your formulary tier placement, then apply for Bristol Myers Squibb's copay

Renewing Stelara (Ustekinumab) Coverage with Cigna in New York: Timeline, Forms, and Appeal Options

Answer Box: Renewing Stelara Coverage with Cigna in New York Cigna requires prior authorization renewal for Stelara every 6 months (initial) to 1 year (continuation). Start renewal 30-45 days before expiration. Submit updated clinical documentation showing continued response via PASI scores, CDAI, or Mayo scores through your prescriber. If coverage

How to Get Breyanzi Covered by UnitedHealthcare in New York: Complete Prior Authorization Guide

Answer Box: Getting Breyanzi Covered by UnitedHealthcare in New York Breyanzi (lisocabtagene maraleucel) requires prior authorization from UnitedHealthcare across all plans in New York. Coverage depends on meeting FDA-approved criteria for relapsed/refractory large B-cell lymphoma or chronic lymphocytic leukemia, plus plan-specific step therapy requirements. Your fastest path to approval:

Renewing Haegarda (C1-Esterase Inhibitor) Approval with Aetna CVS Health in New York: Complete Timeline & Documentation Guide

Answer Box: Renewing Haegarda with Aetna CVS Health in New York Start your Haegarda renewal 30-45 days before expiration. Aetna requires documented attack reduction (≥50%), specialist notes, and completed precertification forms. Submit via CVS Caremark portal or fax to 1-888-267-3277. Standard reviews take 14-30 days; expedited decisions within 72 hours

How to Get Evrysdi (risdiplam) Covered by Aetna CVS Health in New York: Complete PA Guide with Appeals Process

Answer Box: Getting Evrysdi (risdiplam) Covered by Aetna CVS Health in New York Evrysdi (risdiplam) is covered by Aetna CVS Health in New York, but requires prior authorization with genetic testing confirmation and specialist prescription. The fastest path to approval: (1) Ensure your neurologist or geneticist has documented SMA diagnosis

How to Get Palynziq (pegvaliase-pqpz) Covered by Aetna CVS Health in New York: Prior Authorization, Appeals & Cost Assistance

Answer Box: Quick Path to Palynziq Coverage Aetna CVS Health covers Palynziq for adults with PKU when blood phenylalanine is >600 µmol/L despite dietary management. Your fastest path: Have your PKU specialist submit prior authorization with recent Phe labs, documented diet/Kuvan failure, and REMS enrollment confirmation. CVS

How to Get Filsuvez (Birch Triterpenes Topical Gel) Covered by Blue Cross Blue Shield in New York: Decision Tree & Appeal Guide

Answer Box: Getting Filsuvez Covered by Blue Cross Blue Shield in New York Quick Answer: Filsuvez requires prior authorization from Blue Cross Blue Shield for epidermolysis bullosa (EB) patients ≥6 months old. First step: Confirm your EB subtype (dystrophic or junctional) through genetic testing and gather documentation of wound care

How to Get Ruconest Approved by Humana in New York: Timeline, Appeals, and Success Strategies

Answer Box: Getting Ruconest Covered by Humana in New York Timeline: 7 days for standard prior authorization (PA) decisions, 24-72 hours for expedited requests. Key requirement: Step therapy documentation showing why alternatives like icatibant aren't suitable. First step: Have your prescriber submit PA through Humana's electronic

Coding That Helps Get Opsumit (macitentan) Approved in New York with Blue Cross Blue Shield (ICD-10, HCPCS/J-Code, NDC)

Answer Box: Getting Opsumit Approved with Blue Cross Blue Shield in New York Fastest path to approval: Use ICD-10 code I27.0 (primary PAH) or I27.21 (secondary PAH), document NYHA functional class II-III, and ensure pregnancy testing compliance per current FDA labeling (REMS discontinued April 2025). Submit via electronic

Get Thiola / Thiola EC (Tiopronin) Covered by Blue Cross Blue Shield in New York: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Thiola Covered in New York To get Thiola (tiopronin) covered by Blue Cross Blue Shield in New York, you need: (1) confirmed cystinuria diagnosis with urine cystine >500 mg/day, (2) documented failure of conservative therapy (hydration, alkalinization, dietary changes), and (3) specialist prescription from nephrologist/