Topic

New York

A collection of 420 issues

How to Get Venclexta (venetoclax) Covered by Aetna (CVS Health) in New York: Complete PA Guide and Appeals Process

Answer Box: Get Venclexta (venetoclax) Covered by Aetna (CVS Health) in New York Venclexta requires prior authorization from Aetna (CVS Health) with step therapy requirements (documented BTK inhibitor failure for CLL) and mandatory tumor lysis syndrome prevention plans. Submit via CVS Caremark provider portal with complete medical records, FDA indication

Myths vs. Facts: Getting Rebif (Interferon Beta-1a) Covered by Cigna in New York

Answer Box: Getting Rebif (Interferon Beta-1a) Covered by Cigna in New York Rebif is likely non-formulary on Cigna plans, requiring prior authorization with documented MS diagnosis, MRI activity, and neurologist consultation. Most denials stem from incomplete documentation rather than true medical necessity issues. In New York, you have strong appeal

How to Get Tavalisse (Fostamatinib) Covered by Cigna in New York: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Tavalisse Covered by Cigna in New York Tavalisse (fostamatinib) requires prior authorization from Cigna for adults with chronic ITP. You'll need a hematologist's prescription, platelet count <30,000/μL (or <50,000/μL with bleeding), and it's dispensed through

The Requirements Checklist to Get Zokinvy (lonafarnib) Covered by Blue Cross Blue Shield in New York

Answer Box Getting Zokinvy (lonafarnib) covered by Blue Cross Blue Shield in New York requires prior authorization with genetic confirmation of HGPS or processing-deficient progeroid laminopathies. Submit via Availity Essentials or your plan's provider portal with genetic test results, specialist prescription, and BSA calculation (≥0.39 m²). If

Work With Your Rheumatologist to Get Krystexxa (Pegloticase) Approved by Blue Cross Blue Shield in New York: Complete Provider Partnership Guide

Answer Box: Getting Krystexxa Approved by Blue Cross Blue Shield in New York Eligibility: Adults with chronic refractory gout who've failed allopurinol and febuxostat at maximum doses, with persistent uric acid ≥6 mg/dL and ongoing flares or tophi. Fastest path: Work with your rheumatologist to submit prior

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

Answer Box: Getting Pyrukynd (mitapivat) Covered by Aetna CVS Health in New York Pyrukynd (mitapivat) requires prior authorization from Aetna CVS Health and is listed as non-formulary on most 2024-2025 plans. To get approved in New York: (1) Ensure your hematologist has genetic confirmation of pyruvate kinase deficiency with ≥2

How to Get Rapivab (Peramivir) Covered by Blue Cross Blue Shield in New York: Complete Guide to Forms, Appeals, and State Protections

Answer Box: Getting Rapivab Covered in New York Blue Cross Blue Shield (BCBS) plans in New York require prior authorization for Rapivab (peramivir), with strict criteria: acute influenza symptoms ≤48 hours, documented inability to use oral antivirals (Tamiflu, Relenza, Xofluza), and medical necessity justification. Submit through Availity portal or fax

How to Get Xembify Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization Guide

Answer Box: Getting Xembify Approved in New York Xembify (immune globulin subcutaneous) requires prior authorization from Blue Cross Blue Shield in New York for primary immunodeficiency coverage. Submit your PA request through Availity Essentials Authorization app with diagnosis confirmation, lab evidence (low IgG levels), infection history, and weight-based dosing rationale.

Work With Your Doctor to Get Evkeeza (evinacumab-dgnb) Approved by UnitedHealthcare in New York: Complete Prior Authorization Guide

Answer Box: Getting Evkeeza Covered by UnitedHealthcare in New York Evkeeza (evinacumab-dgnb) requires prior authorization from UnitedHealthcare for homozygous familial hypercholesterolemia (HoFH) patients ≥5 years old. Fastest path: Work with your specialist to submit a complete PA request including genetic confirmation of HoFH, documented failure of maximally tolerated therapy (statin

Myths vs. Facts: Getting Tecentriq (Atezolizumab) Covered by UnitedHealthcare in New York

Answer Box: Getting Tecentriq Covered by UnitedHealthcare in New York Myth: If your doctor prescribes Tecentriq, UnitedHealthcare automatically covers it. Fact: UnitedHealthcare requires prior authorization (PA) for Tecentriq (HCPCS J9022) with specific documentation including PD-L1 testing, staging, and prior treatment history. In New York, you have strong appeal rights through