Topic

New York

A collection of 443 issues

How to Get Idelvion (albutrepenonacog alfa) Covered by Aetna CVS Health in New York: Prior Authorization, Appeals, and Success Strategies

Answer Box: Getting Idelvion Covered by Aetna CVS Health in New York Idelvion (albutrepenonacog alfa) requires prior authorization from Aetna CVS Health in New York. Submit requests through the Availity portal at least two weeks before treatment. Include factor IX deficiency confirmation, inhibitor testing results, and documentation of prior therapies.
5 min read

Getting Enbrel (Etanercept) Covered by UnitedHealthcare in New York: A Real Patient Journey From Denial to Approval

Answer Box: Getting Enbrel Covered by UnitedHealthcare in New York Fastest path to approval: Submit prior authorization through UnitedHealthcare's provider portal with specialist prescription, documented DMARD failure, negative TB screening, and medical necessity letter. If denied, file internal appeal within 180 days, then external review through NY Department
5 min read

How to Get Orkambi (lumacaftor/ivacaftor) Covered by Blue Cross Blue Shield in New York: Prior Authorization, Appeals, and Documentation Guide

Answer Box: Getting Orkambi Covered by BCBS in New York Orkambi requires prior authorization from Blue Cross Blue Shield plans in New York. Key requirement: documented F508del homozygous mutation with specialist prescription. Fastest path: Have your CF specialist submit PA through the BCBS provider portal with genetic testing, clinical notes,
6 min read

Blue Cross Blue Shield New York Humira Coverage: Complete Guide to Prior Authorization, Appeals, and Medical Necessity Requirements

Answer Box: Getting Humira Covered by BCBS New York Blue Cross Blue Shield New York requires prior authorization for Humira (adalimumab), with step therapy to biosimilars increasingly required in 2025. Success depends on complete medical necessity documentation including TB/HBV screening, prior therapy failures, and diagnosis-specific criteria. Fastest path to
6 min read