Topic

New York

A collection of 237 issues

Getting Brineura (Cerliponase Alfa) Covered by Cigna in New York: Complete PA Guide and Appeals Process

Answer Box: Getting Started Today To get Brineura (cerliponase alfa) covered by Cigna in New York, you need: 1) Confirmed CLN2 diagnosis with genetic/enzyme testing, 2) Prescription from a pediatric neurologist or specialist, and 3) Prior authorization through Cigna's specialty pharmacy (Express Scripts/Accredo). Start by gathering

How to Get Takhzyro (Lanadelumab) Covered by Blue Cross Blue Shield in New York: Complete Forms Guide

Answer Box: Getting Takhzyro Covered in New York To get Takhzyro (lanadelumab-flyo) covered by Blue Cross Blue Shield in New York: Submit prior authorization through the Availity portal with confirmed HAE diagnosis (C1-INH/C4 labs), attack history documentation, and specialist prescription. If denied, file an internal appeal within plan deadlines,

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

Answer Box: Getting Hemgenix Covered by Aetna CVS Health in New York Hemgenix requires strict prior authorization from Aetna CVS Health in New York. You'll need a hematologist's prescription, documented treatment failure on Factor IX prophylaxis (≥150 exposure days), negative inhibitor tests, and comprehensive lab work.

Work With Your Doctor to Get Tecentriq (atezolizumab) Covered by Aetna (CVS Health) in New York: Forms, Appeals, and Clinical Evidence

Quick Answer: Getting Tecentriq Approved by Aetna in New York Aetna (CVS Health) requires prior authorization for Tecentriq (atezolizumab) with strict biomarker requirements. Your doctor must submit clinical documentation showing FDA-approved indication, PD-L1 testing results (when required), and negative EGFR/ALK mutations for lung cancer. If denied, you have 180

Getting Daybue (Trofinetide) Covered by Cigna in New York: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Fastest Path to Daybue Coverage with Cigna in New York Daybue (trofinetide) requires prior authorization from Cigna and must be dispensed through a designated specialty pharmacy. To get coverage: 1. Submit PA request with confirmed Rett syndrome diagnosis, patient age ≥2 years, and specialist attestation 2. Use Cigna&

Myths vs. Facts: Getting Spinraza (Nusinersen) Covered by Humana in New York

Answer Box: Spinraza Coverage Through Humana in New York Spinraza (nusinersen) requires prior authorization from Humana and must be prescribed by a neurologist with SMA expertise. Key requirements include genetic confirmation of 5q SMA, baseline motor function testing, and comprehensive clinical documentation. If denied, New York patients have strong appeal

How to Get Nourianz (Istradefylline) Covered by Blue Cross Blue Shield in New York: Appeals Guide with Forms and Timelines

Answer Box: Getting Nourianz Covered in New York To get Nourianz (istradefylline) covered by Blue Cross Blue Shield in New York: First, your doctor must submit a prior authorization (PA) request documenting your Parkinson's disease diagnosis, current levodopa therapy, and documented "OFF" episodes. If denied, you

How to Get Krystexxa (Pegloticase) Covered by UnitedHealthcare in New York: Complete Guide to Prior Authorization, Appeals, and Alternatives

Answer Box: Getting Krystexxa Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Krystexxa (pegloticase) with strict step therapy requirements. You must document failed trials of allopurinol and febuxostat, plus G6PD testing and rheumatologist oversight. If denied, New York offers strong external appeal rights through the Department of

How to Get Photrexa (Riboflavin) Covered by Cigna in New York: Complete Cost-Cutting Guide

Answer Box: Getting Photrexa Covered by Cigna in New York Cigna requires prior authorization for Photrexa (riboflavin ophthalmic solution) and classifies it as a specialty medication in Tier 4 or 5. Your out-of-pocket costs can range from hundreds to thousands of dollars per eye, but multiple cost-reduction strategies exist. Three

Getting Revlimid (Lenalidomide) Covered by Humana in New York: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Revlimid Covered by Humana in New York Humana requires prior authorization for Revlimid (lenalidomide) and REMS certification compliance. Start by ensuring your prescriber and pharmacy are REMS-certified, then submit a PA request through Humana's provider portal with complete clinical documentation. If denied, you have 65