Topic

New York

A collection of 443 issues

Getting Ilaris (Canakinumab) Covered by UnitedHealthcare in New York: Complete Prior Authorization and Appeal Guide

Answer Box: Quick Path to Ilaris Coverage in New York UnitedHealthcare requires prior authorization for Ilaris (canakinumab) in New York. Submit through a rheumatologist or immunologist with complete diagnostic documentation, lab results showing inflammation (elevated CRP, ESR, ferritin), and evidence of failed first-line therapies. If denied, you have 180 days

How to Get Trikafta Covered by UnitedHealthcare in New York: Prior Authorization, Appeals & Specialty Pharmacy Guide

Answer Box: Getting Trikafta Covered by UnitedHealthcare in New York Trikafta requires prior authorization from UnitedHealthcare and must be filled through an approved specialty pharmacy like Optum Specialty Pharmacy. The drug is placed on Tier 3 (specialty tier) with the highest cost-sharing. To get approved: (1) Your doctor submits a

Myths vs. Facts: Getting Rystiggo (rozanolixizumab-noli) Covered by Humana in New York

Answer Box: Getting Rystiggo (rozanolixizumab-noli) Covered by Humana in New York Eligibility: Adults with generalized myasthenia gravis who are AChR- or MuSK-antibody positive and have failed standard treatments. Fastest path: Your neurologist submits prior authorization with complete antibody testing, MG-ADL scores ≥5, and documented failure of at least two chronic

Myths vs. Facts: Getting Cometriq (Cabozantinib) Covered by Blue Cross Blue Shield in New York

Answer Box: Quick Facts for New York Patients Getting Cometriq (cabozantinib) covered by Blue Cross Blue Shield in New York requires prior authorization through specialty pharmacy networks. The fastest path: 1) Confirm your diagnosis of metastatic medullary thyroid carcinoma with pathology reports, 2) Have your oncologist submit electronic PA via

How to Get Vimizim (Elosulfase Alfa) Covered by Humana in New York: Requirements, Appeals, and Timeline

Answer Box: Getting Vimizim Covered by Humana in New York Who qualifies: Patients with confirmed MPS IVA (Morquio A syndrome) diagnosis through enzyme testing and genetic confirmation. Fastest approval path: Submit prior authorization with specialist attestation, diagnostic test results, and baseline functional measures. Start today: Contact your prescribing specialist to

Blue Cross Blue Shield New York Coverage Criteria for Busulfex (Busulfan Injection): What Counts as "Medically Necessary"?

Answer Box: Getting Busulfex Covered by Blue Cross Blue Shield in New York Busulfex (busulfan injection) requires prior authorization from Blue Cross Blue Shield plans in New York for stem cell transplant conditioning regimens. The fastest path to approval: 1) Confirm your transplant center is a Blue Distinction Center, 2)

How to Get Dojolvi (Triheptanoin) Covered by Cigna in New York: Complete PA Guide with Appeal Scripts

Answer Box: Getting Dojolvi Covered by Cigna in New York Eligibility: Patients with molecularly confirmed long-chain fatty acid oxidation disorders (LC-FAOD) can get Dojolvi (triheptanoin) covered by Cigna through prior authorization. Fastest path: Submit PA with genetic testing results, metabolic specialist prescription, and documentation that no other MCT products are

Crysvita (Burosumab) Approval with UnitedHealthcare in New York: Complete Guide to Prior Authorization, Appeals, and Coverage

Answer Box: Getting Crysvita Covered by UnitedHealthcare in New York UnitedHealthcare covers Crysvita (burosumab) for X-linked hypophosphatemia (XLH) and tumor-induced osteomalacia (TIO) with prior authorization in New York. Key requirements include confirmed diagnosis via genetic testing or elevated FGF23, specialist prescribing, and documented clinical need. First step today: Contact your

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

Answer Box: Getting Mycapssa Covered by Aetna CVS Health in New York Eligibility: Mycapssa (octreotide oral) requires prior authorization from Aetna CVS Health for acromegaly patients who previously responded to injectable octreotide or lanreotide. Fastest path: Have your endocrinologist submit a PA request through the Availity provider portal with documented

How Long Does It Take to Get Vyndaqel / Vyndamax (tafamidis) Approved by Humana in New York? Complete Timeline Guide

Quick Answer: Vyndaqel / Vyndamax Approval Timeline with Humana Standard approval: 30 days from complete submission. Expedited review: 72 hours if medically urgent. Key requirements: Confirmed ATTR-CM diagnosis (PYP scan or biopsy), NYHA Class I-III, cardiology oversight. Fastest path: Submit complete PA packet with diagnostic imaging, specialist letter, and prior therapy