Topic

New York

A collection of 443 issues

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

Answer Box: Getting Pemazyre Covered by Aetna CVS Health in New York Pemazyre (pemigatinib) requires prior authorization with Aetna CVS Health plans and is often non-formulary, requiring a formulary exception. Success depends on three key elements: documented FGFR2/FGFR1 molecular testing results, comprehensive treatment history, and baseline ophthalmologic exam. First

How Long Does It Take to Get Kalydeco (ivacaftor) Approved by UnitedHealthcare in New York? Complete Timeline & Appeals Guide

Answer Box: Getting Kalydeco Approved by UnitedHealthcare in New York Timeline: 3-14 days for initial decision. UnitedHealthcare must respond to Kalydeco prior authorization requests within 3 business days (non-urgent) or 24 hours (urgent) under New York state law. Most approvals happen within 5-7 days when complete documentation is submitted. Required:

Jaypirca (Pirtobrutinib) Approval with Aetna CVS Health in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Jaypirca (Pirtobrutinib) Covered by Aetna CVS Health in New York Yes, Jaypirca (pirtobrutinib) is covered by Aetna CVS Health but requires prior authorization. The fastest path to approval: 1) Your oncologist submits a prior authorization through Aetna's provider portal with complete documentation of prior BTK

Renewing Ibrance (Palbociclib) Approval with UnitedHealthcare in New York: Timeline, Documents & Appeals

Answer Box: Renewing Ibrance Coverage with UnitedHealthcare in New York UnitedHealthcare requires annual prior authorization renewal for Ibrance (palbociclib), issued for 12-month periods. To renew successfully: (1) Submit reauthorization 30-60 days before expiration with documentation showing no disease progression, (2) Include required CBC monitoring results and any dose modifications, (3)

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

Quick Answer: Getting Nucala (Mepolizumab) Covered by Cigna in New York Eligibility: Nucala requires prior authorization from Cigna for severe eosinophilic asthma (ages 6+) with blood eosinophils ≥150 cells/µL and inadequate control despite high-dose inhaled corticosteroids plus controllers. Fastest path: Submit complete PA request via Cigna provider portal with

How to Get Myalept (Metreleptin) Covered by Cigna in New York: Complete Requirements Guide

Answer Box: Getting Myalept Covered by Cigna in New York Eligibility: Myalept (metreleptin) coverage requires confirmed generalized lipodystrophy with leptin deficiency, prescribed by an endocrinologist or geneticist. Fastest path: Complete Cigna's prior authorization through Express Scripts, enroll in the mandatory REMS program, and document failed standard therapies. First

Do You Qualify for Thiola / Thiola EC Coverage by UnitedHealthcare in New York? Decision Tree & Next Steps

Answer Box: Your Path to Thiola Coverage To get Thiola/Thiola EC covered by UnitedHealthcare in New York, you need: confirmed cystinuria diagnosis (ICD-10: E72.01), documented failure of conservative therapy (alkalinization with potassium citrate for ≥3 months), 24-hour urine cystine levels >250-300 mg/day, and specialist involvement (urologist/

How to Get Qalsody (Tofersen) Covered by UnitedHealthcare in New York: Complete Coding, Appeals & Forms Guide

Answer Box: Getting Qalsody Covered by UnitedHealthcare in New York Qalsody (tofersen) requires prior authorization from UnitedHealthcare and is covered under the medical benefit using J-code J1304. Key requirements: confirmed SOD1 gene mutation, ALS diagnosis (ICD-10: G12.21), baseline neurofilament light chain (NfL) levels, and ALSFRS-R score ≥24. If denied,

How to Get Enbrel (Etanercept) Covered by Aetna CVS Health in New York: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Enbrel Covered by Aetna CVS Health in New York Aetna CVS Health requires prior authorization and step therapy for Enbrel (etanercept). You'll likely need to try biosimilars first unless you have documented contraindications. If denied, New York offers strong external appeal rights through the Department

If Amvuttra Isn't Approved by UnitedHealthcare in New York: Formulary Alternatives & Exception Paths

Answer Box: Your Next Steps if Amvuttra is Denied If UnitedHealthcare denied Amvuttra (vutrisiran) for TTR amyloidosis in New York, you have several paths forward. First, review which formulary alternatives your plan covers—typically Onpattro, Tegsedi, or Vyndaqel depending on your condition type. Second, work with your specialist to document