Topic

New York

A collection of 443 issues

Getting Kineret (Anakinra) Covered by Humana in New York: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Quick Path to Approval Kineret (anakinra) requires prior authorization from Humana in New York. Your fastest path: 1) Have your rheumatologist submit a PA request with documentation of failed DMARDs/biologics and infection screening, 2) If denied, file an internal appeal within 65 days, 3) For urgent needs,

How to Get Oxbryta (Voxelotor) Covered by Cigna in New York: 2024 Withdrawal Update and Alternative Paths

Answer Box: Critical Update on Oxbryta (Voxelotor) Coverage Important: Oxbryta (voxelotor) was voluntarily withdrawn from the U.S. market by Pfizer in September 2024 due to safety concerns and insufficient clinical benefit. The drug is no longer FDA-approved and cannot be prescribed or covered by any U.S. insurer, including

Get Arcalyst (Rilonacept) Covered by Aetna CVS Health in New York: Complete Coding, Billing & Appeals Guide

Answer Box: Quick Path to Arcalyst Coverage Arcalyst (rilonacept) requires prior authorization from Aetna CVS Health for all FDA-approved indications. In New York, submit the CVS Caremark specialty PA form with diagnosis documentation (ICD-10 M04.2 for CAPS, I31.9 for recurrent pericarditis), prior therapy failures, and specialist consultation. If

How to Get Evkeeza (Evinacumab-dgnb) Covered by Humana in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Evkeeza Covered by Humana in New York Evkeeza (evinacumab-dgnb) is covered by Humana Medicare Advantage plans but requires prior authorization. For fastest approval: (1) Your provider submits genetic testing results confirming homozygous familial hypercholesterolemia (HoFH), documented LDL-C levels >400-500 mg/dL, and records of maximally tolerated

How to Get Strimvelis Gene Therapy Covered by Blue Cross Blue Shield in New York: Complete Guide with Forms and Appeals

Answer Box: Getting Strimvelis Covered by Blue Cross Blue Shield in New York Strimvelis is not routinely covered by Blue Cross Blue Shield New York and requires a comprehensive medical exception request. Since Strimvelis is only available at SR-TIGET in Milan, Italy, you'll need both drug coverage approval

How to Get Turalio (Pexidartinib) Covered by Humana in New York: Coding, Prior Authorization, and Appeals Guide

Answer Box: Getting Turalio Covered by Humana in New York Turalio (pexidartinib) requires prior authorization from Humana for tenosynovial giant cell tumor (TGCT) when surgery isn't an option. First step today: Ensure your prescriber is REMS-certified and gather baseline liver function tests. Submit PA via Humana's

Do You Qualify for Prolastin-C Coverage by Blue Cross Blue Shield in New York? Decision Tree & Next Steps

Answer Box: Getting Prolastin-C Covered in New York To get Prolastin-C covered by Blue Cross Blue Shield in New York, you need: (1) Confirmed severe alpha-1 antitrypsin deficiency (Pi*ZZ genotype), (2) FEV1 between 30-65% predicted, and (3) clinical evidence of emphysema. First step today: Contact your pulmonologist to order

How to Get Koselugo (Selumetinib) Covered by UnitedHealthcare in New York: Prior Authorization Forms, Appeal Scripts & Timelines

Answer Box: Fast Track to Koselugo Coverage in New York For pediatric patients under 19 with NF1 and plexiform neurofibromas, UnitedHealthcare typically auto-approves Koselugo (selumetinib) based on age alone. If denied, you have strong appeal rights in New York through the Department of Financial Services external review process. First step

How to Get Elzonris (tagraxofusp-erzs) Covered by Humana in New York: Appeals, Forms & State Protections

Answer Box: Getting Elzonris Covered by Humana in New York Fastest path to approval: Submit prior authorization with complete BPDCN pathology (CD123+ confirmation), capillary leak syndrome monitoring plan, and medical necessity letter citing failed alternatives. If denied, file internal appeal within 65 days, then external review through New York DFS

How to Get Darzalex Covered by Cigna in New York: Appeal Templates, Timelines & Prior Authorization Guide

Answer Box: Getting Darzalex Covered by Cigna in New York If Cigna denies Darzalex (daratumumab) coverage, you can appeal within 180 days. Most denials stem from insufficient prior therapy documentation or missing age verification (≥18 required). Quick action steps: 1) Call Cigna at 1-800-882-4462 for clarification, 2) Gather complete treatment