Topic

New York

A collection of 42 issues

Getting Dojolvi (Triheptanoin) Covered by Aetna CVS Health in New York: Complete Guide to Approval, Appeals & Forms

Answer Box: Quick Path to Coverage Dojolvi (triheptanoin) is not on Aetna's 2024 formulary, requiring a formulary exception or prior authorization based on medical necessity. In New York, you have strong appeal rights through the state's external review system if initially denied. Fastest approval path: 1.

How to Get Thiola / Thiola EC (tiopronin) Covered by Aetna CVS Health in New York: Complete PA Guide

Answer Box: Quick Path to Thiola Coverage Getting Thiola/Thiola EC covered by Aetna CVS Health in New York requires prior authorization with step therapy documentation. Submit a complete PA request through the Availity portal including: confirmed cystinuria diagnosis (24-hour urine cystine ≥300 mg/day), documented failure of conservative therapy,

Get Oxervate (Cenegermin) Covered by Cigna in New York: Prior Authorization Guide, Appeals Process & Alternative Treatments

Answer Box: Getting Oxervate (Cenegermin) Covered by Cigna in New York Oxervate (cenegermin) requires prior authorization from Cigna and typically involves step therapy with alternatives like preservative-free artificial tears and autologous serum drops first. If denied, you have 180 days for internal appeals and can request external review through New

How to Get Ibrance (Palbociclib) Covered by Humana in New York: Prior Authorization, Appeals & Financial Aid

Answer Box: Getting Ibrance (Palbociclib) Covered by Humana in New York Ibrance (palbociclib) requires prior authorization from Humana and is classified as a Tier 5 specialty drug with copays ranging from $168-$764 per month. Your fastest path to approval: 1. Have your oncologist submit prior authorization with HR+/HER2-

How to Get Rinvoq (upadacitinib) Covered by Blue Cross Blue Shield in New York: Complete Guide to Forms, Appeals & Approval

Answer Box: Getting Rinvoq Covered by BCBS New York Blue Cross Blue Shield New York requires prior authorization for Rinvoq (upadacitinib), typically with step therapy requirements. Your fastest path to approval: (1) Have your doctor complete the BCBS PA form with detailed medical necessity documentation, (2) Submit through the Availity

How to Get Cosentyx (Secukinumab) Covered by Humana in New York: Prior Authorization, Appeals, and Step Therapy Guide

Answer Box: Getting Cosentyx Covered by Humana in New York Cosentyx (secukinumab) requires prior authorization from Humana and typically sits on Tier 5 (Specialty) with step therapy requirements. Your fastest path to approval: Have your doctor submit a PA request with documented failure of preferred biologics, negative TB screening, and

Work With Your Doctor to Get Qinlock (ripretinib) Covered by Aetna (CVS Health) in New York: Prior Authorization Guide

Answer Box: Getting Qinlock (ripretinib) Covered by Aetna (CVS Health) in New York Eligibility: Qinlock requires prior authorization from Aetna (CVS Health) for fourth-line GIST treatment after progression on imatinib, sunitinib, and regorafenib. Fastest path: Work with your oncologist to submit comprehensive treatment history documentation showing failure/intolerance to all

Getting Orfadin (Nitisinone) Covered by Cigna in New York: Coding, Appeals & Prior Authorization Guide

Answer Box: Getting Orfadin (Nitisinone) Covered by Cigna in New York Orfadin (nitisinone) for hereditary tyrosinemia type 1 requires Cigna prior authorization using ICD-10 code E70.29 and HCPCS J8499. Key steps: 1) Confirm HT-1 diagnosis with elevated succinylacetone levels, 2) Submit PA with specialist documentation and dietary management plan,

How to Get Darzalex Covered by Humana in New York: Step Therapy Laws, Appeals Process, and Prior Authorization Guide

Answer Box: Getting Darzalex Covered by Humana in New York Darzalex (daratumumab) requires prior authorization from Humana Medicare Advantage plans in New York. If denied, you can appeal internally and request external review through the New York Department of Financial Services (DFS) within four months. New York's step

How to Get Enbrel (etanercept) Covered by Blue Cross Blue Shield in New York: Complete Requirements Guide

Answer Box: Getting Enbrel Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield plans in New York require prior authorization for Enbrel (etanercept) with step therapy requirements favoring biosimilars first. Your fastest path to approval: 1) Have your rheumatologist or dermatologist document failed trials of preferred