Topic

New York

A collection of 237 issues

If Kesimpta Isn't Approved by Blue Cross Blue Shield in New York: Formulary Alternatives & Exception Paths

Answer Box: Kesimpta Alternatives with BCBS New York If Blue Cross Blue Shield denies Kesimpta (ofatumumab) in New York, formulary alternatives include Ocrevus, Tysabri, Tecfidera, and interferon-based DMTs. Most BCBS NY plans require step therapy with oral or injectable DMTs before approving high-cost biologics. Your fastest path: request a formulary

Myths vs. Facts: Getting Onivyde (Irinotecan Liposome) Covered by Cigna in New York

Answer Box: Getting Onivyde Covered by Cigna in New York Eligibility: Cigna requires prior authorization for Onivyde (irinotecan liposome) with strict ECOG performance status (0-1), documented pancreatic adenocarcinoma, and specific organ function labs. Fastest path: Electronic submission via CoverMyMeds or provider portal with complete clinical documentation. First step today: Gather

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

Quick Answer: Cigna requires prior authorization for Cabometyx (cabozantinib tablets) with documentation of FDA-approved diagnosis, prior therapy failures, and medical necessity. Your oncologist submits through Cigna's portal or CoverMyMeds within 72 hours standard review. If denied, you have 180 days for internal appeal, then 4 months for New

How to Get Defitelio (Defibrotide) Covered by Humana in New York: PA Requirements, Appeals, and State Protections

Answer Box: Getting Defitelio (Defibrotide) Covered by Humana in New York Defitelio (defibrotide) requires prior authorization from Humana Medicare Advantage plans for hepatic veno-occlusive disease (VOD/SOS) with organ dysfunction post-HSCT. Coverage is limited to FDA-approved indication only. Fastest path to approval: Have your transplant physician submit PA request with

How to Get Xyrem (Sodium Oxybate) Covered by Humana in New York: Complete Guide to Alternatives, Appeals & Approvals

Answer Box: Quick Path to Xyrem Coverage If Xyrem isn't initially approved by Humana in New York, you have three main options: try covered alternatives first (step therapy), request a formulary exception with medical necessity documentation, or appeal any denial through New York's external review process.

How to Get Oxervate (Cenegermin) Covered by Humana in New York: Appeals, Forms, and Financial Assistance

Answer Box: Getting Oxervate Covered by Humana in New York Quick Path to Approval: Oxervate (cenegermin) requires prior authorization from Humana and is typically non-formulary or specialty tier. Success depends on documenting stage 2/3 neurotrophic keratitis diagnosis, failed conventional treatments, and corneal nerve damage evidence. If denied, New York

How to Get Opzelura (Ruxolitinib Cream) Covered by Blue Cross Blue Shield in New York: Forms, Appeals & Contact Info

Answer Box: Getting Opzelura Covered by BCBS New York Blue Cross Blue Shield New York requires prior authorization for Opzelura (ruxolitinib cream). To get approval: 1) Have your dermatologist document failed topical steroids/calcineurin inhibitors, 2) Submit the PA request through Availity Essentials portal with clinical records, and 3) If

How to Get Besponsa (Inotuzumab Ozogamicin) Covered by Blue Cross Blue Shield in New York: Coding, Appeals, and Documentation Guide

Answer Box: Getting Besponsa Covered by Blue Cross Blue Shield in New York Besponsa (inotuzumab ozogamicin) requires prior authorization from Blue Cross Blue Shield plans in New York for relapsed/refractory CD22-positive B-cell precursor ALL. The fastest path to approval involves: (1) Submit complete PA request with ICD-10 code C91.

Renewing Myalept (Metreleptin) Approval with Aetna CVS Health in New York: Complete Renewal Guide

Answer Box: Renewing Your Myalept Coverage Fastest renewal path: Submit your renewal request 30-45 days before your current authorization expires. Aetna requires documented improvement in metabolic control (HbA1c, triglycerides, or liver enzymes) plus continued REMS compliance. If denied, you have 180 days for internal appeals and 4 months for New

How to Get Translarna (Ataluren) Covered by Humana in New York: Timeline, Appeals & Required Documentation

Quick Answer: Getting Translarna (Ataluren) Covered by Humana in New York Timeline: 14 days for standard prior authorization (reducing to 7 days in 2026), 72 hours for urgent requests. Requirements: Genetic testing confirming nonsense mutation DMD, 6-minute walk test results, specialist prescription, and annual renewal documentation. First step: Contact your