Topic

New York

A collection of 497 issues

How to Get Elzonris (tagraxofusp-erzs) Covered by Blue Cross Blue Shield in New York: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Elzonris Covered in New York Elzonris (tagraxofusp-erzs) requires prior authorization from Blue Cross Blue Shield for BPDCN treatment. New York patients need: confirmed BPDCN diagnosis with CD123-positive pathology, serum albumin ≥3.2 g/dL, and a capillary leak syndrome monitoring plan. If denied, you have 4 months

Get Revlimid (Lenalidomide) Covered by Cigna in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Revlimid (Lenalidomide) Covered by Cigna in New York Revlimid (lenalidomide) requires prior authorization through Cigna Express Scripts, with mandatory FDA REMS program compliance. Start by ensuring your prescriber is REMS-certified and gather complete documentation: ICD-10 diagnosis codes, prior therapy records, recent labs, and treatment rationale per NCCN

Do You Qualify for Voydeya (danicopan) Coverage by Blue Cross Blue Shield in New York? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Voydeya Coverage If you have paroxysmal nocturnal hemoglobinuria (PNH) with extravascular hemolysis despite C5 inhibitor therapy, you likely qualify for Voydeya (danicopan) coverage through Blue Cross Blue Shield in New York. The fastest approval path requires: (1) Current C5 inhibitor therapy (Soliris/Ultomiris), (2)

Getting Defitelio (Defibrotide) Covered by Blue Cross Blue Shield in New York: PA Requirements, Appeals, and Cost Assistance

Answer Box: Getting Defitelio Covered by Blue Cross Blue Shield in New York Defitelio (defibrotide) requires prior authorization from Blue Cross Blue Shield plans in New York for hepatic veno-occlusive disease (VOD) with organ dysfunction post-HSCT. Your fastest path: (1) Have your transplant team submit PA with VOD diagnosis documentation

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Enhertu Covered by BCBS in New York Enhertu (fam-trastuzumab deruxtecan-nxki) requires prior authorization from Blue Cross Blue Shield plans in New York for HER2-positive breast cancer, NSCLC, and gastric cancer. Key requirements include documented HER2 status (IHC 3+ or ISH amplified), prior trastuzumab-based therapy failure, and NCCN

The Requirements Checklist to Get Fintepla (fenfluramine) Covered by UnitedHealthcare in New York: Forms, Appeals, and REMS Documentation

Answer Box: Getting Fintepla Covered by UnitedHealthcare in New York To get Fintepla (fenfluramine) covered by UnitedHealthcare in New York: First, enroll in the mandatory Fintepla REMS program and complete baseline echocardiography. Then submit prior authorization through UnitedHealthcare's provider portal with diagnosis confirmation (ICD-10 G40.83 for Dravet

Blue Cross Blue Shield New York Coverage Criteria for Rezlidhia (Olutasidenib): Complete Prior Authorization and Appeals Guide

Answer Box: Getting Rezlidhia Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield of New York requires prior authorization for Rezlidhia (olutasidenib) in adults with relapsed/refractory AML and susceptible IDH1 mutation. Your fastest path to approval: 1) Confirm IDH1 mutation via FDA-approved test, 2) Submit

How Long Does It Take to Get Orladeyo (Berotralstat) Approved by Cigna in New York? Complete Timeline & Appeals Guide

Answer Box: Fast-Track to Orladeyo Coverage Cigna typically approves Orladeyo (berotralstat) within 2 days if you submit complete documentation through Express Scripts. Key requirements: HAE type I/II diagnosis with low C1-INH (<50% normal), HAE specialist prescription, and lab documentation. If denied, file an internal appeal within 180 days,

How to Get Rezlidhia (Olutasidenib) Covered by UnitedHealthcare in New York: Prior Authorization Guide

Answer Box: Getting Rezlidhia Covered by UnitedHealthcare in New York Rezlidhia (olutasidenib) requires prior authorization from UnitedHealthcare OptumRx in New York. You'll need documented IDH1 mutation results, confirmed relapsed/refractory AML diagnosis, and evidence of prior therapy failures. Submit through the UnitedHealthcare Provider Portal with complete documentation for

Renewing Joenja (Leniolisib) Approval with UnitedHealthcare in New York: Timeline, Evidence & Bridge Options

Answer Box: Renewing Joenja Coverage with UnitedHealthcare in New York Good news: UnitedHealthcare's OptumRx has eliminated reauthorization requirements for many chronic condition drugs, potentially including Joenja (leniolisib) for APDS patients. Under the updated policy, no periodic renewal is needed for qualifying lifelong therapies unless safety monitoring or dose