Topic

New York

A collection of 420 issues

Do You Qualify for Orfadin (Nitisinone) Coverage by Aetna CVS Health in New York? Decision Tree & Next Steps

Answer Box: Your Path to Orfadin Coverage Aetna CVS Health requires prior authorization for Orfadin (nitisinone) in New York, with approval based on confirmed hereditary tyrosinemia type 1 (HT-1) diagnosis, elevated succinylacetone levels (>2 μmol/L), and dietary management plan. Standard decisions take 72 hours; expedited cases 24 hours.

How to Get Cystadane (Betaine Anhydrous) Covered by Aetna CVS Health in New York: Prior Authorization Guide with Appeal Scripts

Answer Box: Getting Cystadane (Betaine Anhydrous) Covered by Aetna CVS Health in New York Cystadane requires prior authorization from Aetna CVS Health in New York, with 12-month approvals typically granted when you provide genetic confirmation of homocystinuria, documented vitamin therapy trials, and current lab values. Submit renewals via Availity provider

How to Get Hetlioz (Tasimelteon) Covered by Cigna in New York: Complete Prior Authorization Guide and Appeals Process

Answer Box: Getting Hetlioz Covered by Cigna in New York Cigna requires prior authorization for Hetlioz (tasimelteon) with documented failure of 6 months of daily melatonin therapy for Non-24-hour sleep-wake disorder in totally blind adults. The fastest path to approval: (1) Gather sleep logs showing irregular patterns and melatonin trial

How to Get Kymriah (tisagenlecleucel) Covered by UnitedHealthcare in New York: Prior Authorization Guide, Appeal Process & Alternative Options

Answer Box: Getting Kymriah Covered by UnitedHealthcare in New York Kymriah (tisagenlecleucel) requires prior authorization from UnitedHealthcare for relapsed/refractory B-cell ALL (patients ≤25 years) and DLBCL after two or more prior therapies. Your fastest path: Have your hematologist/oncologist submit PA documentation through UHCprovider.com with confirmed diagnosis, prior

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

Answer Box: Getting Uptravi Covered by Blue Cross Blue Shield in New York Uptravi (selexipag) requires prior authorization from Blue Cross Blue Shield plans in New York for pulmonary arterial hypertension (PAH). Success depends on documenting WHO Group I PAH via right heart catheterization, failed trials of background therapies, and

How to Get Darzalex Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Darzalex Approved by Blue Cross Blue Shield in New York Darzalex requires prior authorization from all Blue Cross Blue Shield plans in New York. Submit your PA request using plan-specific forms with complete documentation: multiple myeloma diagnosis (ICD-10 C90.0), prior therapy failures, and medical necessity justification.

How to Get Exondys 51 (Eteplirsen) Covered by UnitedHealthcare in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Exondys 51 Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Exondys 51 (eteplirsen) with specific criteria: confirmed DMD with exon 51-amenable mutation, ambulatory status, specialist prescriber, and baseline testing. First step: Contact a DMD specialist at Mount Sinai or NYU Langone to order genetic

Myths vs. Facts: Getting Voydeya (danicopan) Covered by Aetna (CVS Health) in New York

Answer Box: Getting Voydeya (danicopan) Covered by Aetna (CVS Health) in New York Voydeya (danicopan) requires prior authorization from Aetna CVS Health for PNH patients with extravascular hemolysis. Key requirements include confirmed PNH diagnosis by flow cytometry, current C5 inhibitor therapy, documented EVH evidence (labs showing persistent anemia/hemolysis), REMS

How to Get Xospata (Gilteritinib) Covered by UnitedHealthcare in New York: Forms, Appeals, and Provider Contacts

Answer Box: Getting Xospata Covered by UnitedHealthcare in New York Xospata (gilteritinib) requires prior authorization from UnitedHealthcare for relapsed/refractory FLT3-mutated AML. Key steps: (1) Submit PA via UnitedHealthcare Provider Portal with FLT3 mutation test and prior therapy records, (2) If denied, file internal appeal within 180 days, (3) Request

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

Answer Box: Quick Path to Approval To get Revlimid (lenalidomide) covered by Aetna (CVS Health) in New York: First, ensure your prescriber and pharmacy are enrolled in the mandatory Lenalidomide REMS program. Submit prior authorization through Aetna's provider portal with diagnosis codes, prior therapy documentation, and REMS certification