Topic

New York

A collection of 443 issues

How to Get Filsuvez (Birch Triterpenes Gel) Covered by Cigna in New York: Complete Cost & Appeals Guide 2025

Answer Box: Getting Filsuvez Covered by Cigna in New York Filsuvez (birch triterpenes gel) requires prior authorization from Cigna and isn't on standard formularies. Three-step path: (1) Your doctor submits a PA with EB diagnosis confirmation and prior therapy documentation to Cigna at 1-800-882-4462, (2) If denied, file

How to Get Helixate (Antihemophilic Factor VIII) Covered by Cigna in New York: Coding, Appeals, and State Resources

Answer Box: Getting Helixate Covered by Cigna in New York Important Update: Helixate FS and Kogenate FS are discontinued in the United States as of 2022-2023. Cigna no longer covers these products on their formulary. Your fastest path to coverage: Work with your hemophilia treatment center to transition to a

How to Get Imbruvica (Ibrutinib) Covered by Cigna in New York: Prior Authorization Guide and Appeal Strategies

Quick Answer: Cigna requires prior authorization for Imbruvica (ibrutinib) in New York, typically placing it on Tier 4-5 with step therapy requirements for preferred BTK inhibitors first. Submit PA through Express Scripts/Accredo with complete diagnostic documentation. If denied, you have 180 days for internal appeals, then 4 months for

UnitedHealthcare's Coverage Criteria for Myozyme (Alglucosidase Alfa) in New York: What Counts as "Medically Necessary"?

Answer Box: Getting Myozyme Covered by UnitedHealthcare in New York To get Myozyme (alglucosidase alfa) approved by UnitedHealthcare in New York, you need: confirmed Pompe disease diagnosis (genetic testing + enzyme deficiency), specialist evaluation by a neurologist or metabolic physician, and prior authorization with comprehensive clinical documentation. If denied, New York&

Work With Your Doctor to Get Palynziq (pegvaliase-pqpz) Approved by UnitedHealthcare in New York

Answer Box: Your Fastest Path to Palynziq Coverage UnitedHealthcare requires prior authorization for Palynziq with mandatory step therapy—you must try sapropterin first or document contraindications. Partner with your PKU specialist to gather blood phenylalanine levels >600 µmol/L, document diet compliance, and complete REMS enrollment. If denied, New

How to Get Trikafta Covered by Humana in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Get Trikafta Covered by Humana in New York Fastest path to approval: Ensure your CF specialist submits a complete prior authorization with documented CFTR genotype (≥1 F508del mutation), baseline liver function tests, and pulmonary function data through Humana's provider portal. If denied, you have 65 days

How to Get Alprolix (Factor IX) Covered by Cigna in New York: PA Requirements, Appeals Process, and State Protections

Answer Box: Getting Alprolix Covered by Cigna in New York Cigna typically requires prior authorization (PA) for Alprolix through Express Scripts/Accredo, with decisions within 24-72 hours under New York law. If denied, you have 180 days to file internal appeals, followed by New York's external review process

Getting Zolgensma Covered by Aetna CVS Health in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered in New York Aetna CVS Health requires strict prior authorization for Zolgensma in New York. Your child must be under 2 years old with confirmed SMN1 mutations and anti-AAV9 antibody titers ≤1:50. First step: Have your SMA specialist gather genetic test results and submit

How to Get Qalsody (Tofersen) Covered by Cigna in New York: Complete Appeals Guide with Templates

Answer Box: Getting Qalsody (Tofersen) Covered by Cigna in New York Qalsody (tofersen) requires prior authorization from Cigna, with documented SOD1 mutation and step therapy completion. If denied, you have 180 days for internal appeals and 4 months for New York's external review through the Department of Financial

How to Get Acthar Gel Covered by Cigna in New York: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Acthar Gel Covered by Cigna in New York Cigna requires prior authorization for Acthar Gel (repository corticotropin injection) with documented failure or contraindication to corticosteroids for approved indications like infantile spasms and MS exacerbations. Submit your PA request through CoverMyMeds or fax Cigna's current PA