Topic

New York

A collection of 516 issues

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

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
6 min read