Topic

New York

A collection of 443 issues

Myths vs. Facts: Getting Luxturna (Voretigene Neparvovec-rzyl) Covered by Cigna in New York

Answer Box: Fast Track to Luxturna Coverage Myth-busting reality: Cigna covers Luxturna in New York, but requires prior authorization with genetic testing proving biallelic RPE65 mutations and retinal viability documentation. Most denials stem from incomplete paperwork, not medical necessity. Your fastest path: Submit complete PA with CLIA-certified genetic results through

How to Get StrataGraft Approved by Cigna in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting StrataGraft Covered by Cigna in New York StrataGraft requires prior authorization under Cigna's medical benefit (not pharmacy) in New York. The fastest path to approval: 1) Confirm your provider is in-network, 2) Submit Cigna's tissue-engineered skin substitute PA form with complete burn documentation

Myths vs. Facts: Getting Zokinvy (lonafarnib) Covered by Cigna in New York

Answer Box: Zokinvy Coverage by Cigna in New York Eligibility: Patients ≥12 months with confirmed HGPS (genetic testing required) and BSA ≥0.39 m². Fastest path: Submit prior authorization through Cigna's specialty pharmacy (typically Accredo) with complete genetic documentation and specialist prescription. First step today: Contact your geneticist

Myths vs. Facts: Getting Natpara (Parathyroid Hormone) Covered by UnitedHealthcare in New York

Answer Box: The Reality of Natpara Coverage in New York Myth-Busting Summary: Natpara (parathyroid hormone) is being discontinued by Takeda, with all U.S. shipments ending December 31, 2025. UnitedHealthcare is not approving new patients for Natpara, only maintaining existing Special Use Program enrollees. New York residents facing denials should

How to Get Epidiolex (Cannabidiol) Covered by Aetna CVS Health in New York: Complete Guide with Appeals Process

Quick Answer: Getting Epidiolex Covered by Aetna CVS Health in New York Aetna CVS Health requires prior authorization for Epidiolex (cannabidiol) in New York for patients with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex. The fastest path: have your prescriber submit a PA request with diagnosis confirmation and prior

How to Get Imbruvica (Ibrutinib) Approved by Humana in New York: Timeline, Appeals, and Documentation Guide

Answer Box: Getting Imbruvica Covered by Humana in New York Fastest path to approval: Humana typically requires prior authorization for Imbruvica (ibrutinib), with decisions within 7 days for standard requests or 72 hours for expedited reviews. Your prescriber must submit pathology reports confirming CLL/SLL/Waldenström macroglobulinemia, flow cytometry results,

Getting Taltz (Ixekizumab) Covered by Humana in New York: Prior Authorization, Appeals & Cost-Saving Strategies

Quick Answer: Getting Taltz (Ixekizumab) Covered by Humana in New York Taltz requires prior authorization from Humana and is typically placed on Specialty Tier 5 with the highest copays. Your fastest path to approval: 1) Have your prescriber submit a PA request with documentation of your psoriasis/arthritis diagnosis, failed

How to Get Prolastin-C Approved by Humana in New York: Timeline, Appeals, and Step-by-Step Guide

Answer Box: Getting Prolastin-C Covered by Humana in New York Fastest path to approval: Submit prior authorization with documented severe AAT deficiency (Pi*ZZ genotype), failed Aralast trial, and specialist consultation. Humana must respond within 14 days for standard requests, 72 hours for expedited. If denied, file internal appeal within

How to Get Hemlibra (Emicizumab) Covered by UnitedHealthcare in New York: Complete Cost-Cutting Guide

Answer Box: Getting Hemlibra Covered by UnitedHealthcare in New York Hemlibra (emicizumab) requires prior authorization from UnitedHealthcare, dispensed through specialty pharmacy (typically Optum), with commercial patients eligible for up to $15,000 annual copay assistance. Key requirements: confirmed hemophilia A diagnosis, inhibitor status documentation, and prophylaxis indication. If denied, New

Coding That Helps Get Poteligeo (mogamulizumab-kpkc) Approved in New York with Aetna (CVS Health): ICD-10, HCPCS J-Code, and NDC Requirements

Answer Box: Getting Poteligeo Covered by Aetna in New York Key codes needed: ICD-10 C84.0x (mycosis fungoides) or C84.1x (Sézary syndrome), HCPCS J9204, NDC 42388-0302-01. Fastest path: Submit prior authorization with accurate weight-based dosing calculation (1 mg/kg), documented prior systemic therapy failure, and staging details. First step