Topic

New York

A collection of 42 issues

Get Arcalyst (Rilonacept) Covered by Blue Cross Blue Shield in New York: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Arcalyst Covered in New York Yes, Blue Cross Blue Shield plans in New York cover Arcalyst (rilonacept) for approved conditions—but prior authorization is required. The fastest path: Have your specialist submit a PA request with complete documentation of your diagnosis (CAPS, DIRA, or recurrent pericarditis), prior

How to Get Bavencio (Avelumab) Covered by UnitedHealthcare in New York: Prior Authorization, Appeals, and Cost Reduction Strategies

Answer Box: Getting Bavencio Covered by UnitedHealthcare in New York Bavencio (avelumab) requires prior authorization from UnitedHealthcare and is dispensed through specialty pharmacies only. In New York, if denied, you can file an external appeal with the Department of Financial Services within 4 months. First step today: Contact your oncologist

Renewing Venclexta (venetoclax) Approval with Cigna in New York: Complete Timeline & Documentation Guide

Answer Box: Renewing Venclexta (venetoclax) with Cigna in New York Quick Path: Start renewal 4-6 weeks before expiration. Submit updated clinical notes, recent CBC/chemistry labs, TLS monitoring records, and response documentation through your oncologist's office. Cigna typically approves renewals within 5 business days for complete submissions. If

The Complete Guide to Getting Revcovi (Elapegademase) Covered by Blue Cross Blue Shield in New York: Forms, Appeals, and Success Strategies

Answer Box: Getting Revcovi Covered in New York Blue Cross Blue Shield plans in New York require prior authorization for Revcovi (elapegademase) to treat ADA-SCID. Fastest path to approval: Confirm your ADA-SCID diagnosis with genetic testing or enzyme activity <1% of normal, ensure prescription from an immunologist/specialist, and

How Long Does It Take to Get Soliris (Eculizumab) Approved by Blue Cross Blue Shield in New York? Complete Timeline & Appeal Guide

Answer Box: Getting Soliris (Eculizumab) Covered by Blue Cross Blue Shield in New York Standard approval timeline: 1-5 days for complete submissions through Blue Cross Blue Shield's electronic portal. Key requirements include FDA-approved diagnosis documentation, meningococcal vaccination records, and REMS enrollment proof. Start today: Gather vaccination records and

Work With Your Doctor to Get Sumavel DosePro Covered by Humana in New York: Complete Prior Authorization Guide

Answer Box: Getting Sumavel DosePro Covered by Humana in New York Note: Sumavel DosePro has been discontinued in the U.S. However, if you have a prescription or need coverage for similar needle-free sumatriptan delivery systems, Humana Medicare Advantage requires step therapy with oral triptans first. You'll need

Get Hemlibra (Emicizumab) Covered by Humana in New York: Complete Guide to Prior Authorization and Appeals

Answer Box: Quick Path to Hemlibra Coverage Hemlibra (emicizumab) requires prior authorization from Humana Medicare plans. To get approved in New York: 1) Have your hematologist submit a PA request with hemophilia A diagnosis, FVIII inhibitor test results, and treatment history to Humana at 877-486-2621. 2) If denied, request a

How to Get Voydeya (Danicopan) Covered by UnitedHealthcare in New York: Complete Guide to Approval and Appeals

Answer Box: Getting Voydeya Covered in New York Yes, UnitedHealthcare covers Voydeya (danicopan) in New York with prior authorization. The fastest path: 1) Confirm you're on a C5 inhibitor (eculizumab/ravulizumab), 2) Have your doctor submit PA through UnitedHealthcare's provider portal with PNH diagnosis and evidence

How to Get Carbaglu (Carglumic Acid) Covered by Aetna CVS Health in New York: Prior Authorization Guide and Appeals Process

Answer Box: Getting Carbaglu Covered by Aetna CVS Health in New York Aetna CVS Health covers Carbaglu (carglumic acid) for NAGS deficiency and certain organic acidemias with prior authorization. Key requirements: confirmed diagnosis via genetic/biochemical testing and documented elevated plasma ammonia levels. If denied, New York residents can appeal

How to Get Epidiolex (Cannabidiol) Covered by Blue Cross Blue Shield in New York: Complete Decision Tree & Appeal Guide

Answer Box: Your Path to Epidiolex Coverage Epidiolex requires prior authorization from Blue Cross Blue Shield New York plans in 2024. You'll likely qualify if you have a confirmed diagnosis of Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex, plus documented failure of standard anti-seizure medications. First step