Topic

New York

A collection of 498 issues

Getting Natpara (Parathyroid Hormone) Coverage from Aetna CVS Health in New York: 2025 Discontinuation Guide and Alternative Options

Answer Box: Natpara Coverage Status in New York Natpara (parathyroid hormone) is no longer available for new prescriptions as Takeda discontinued global manufacturing in December 2024. Aetna CVS Health automatically denies all new Natpara requests regardless of medical necessity. For New York patients: 1) Discuss Yorvipath (FDA-approved August 2024) with

Myths vs. Facts: Getting Vyondys 53 (golodirsen) Covered by UnitedHealthcare in New York

Answer Box: Getting Vyondys 53 Covered by UnitedHealthcare in New York Vyondys 53 (golodirsen) requires prior authorization from UnitedHealthcare and is billed as a medical benefit under J1429. Key requirements: confirmed exon 53-amenable DMD mutation via genetic testing, ambulatory status (6MWT ≥300m), and neuromuscular specialist involvement. If denied, New York

Renewing Rinvoq (Upadacitinib) Approval with UnitedHealthcare in New York: Timeline, Documentation & Appeal Options

Answer Box: UnitedHealthcare approves Rinvoq renewals for 12 months with documented clinical response and safety labs. Start renewal 45-60 days before expiration by scheduling response assessment, gathering current labs (CBC, liver function, lipids), and submitting via OptumRx portal. If denied, file internal appeal within 180 days, then external review through

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

Answer Box: Getting Photrexa Covered by Aetna CVS Health in New York Yes, Aetna CVS Health covers Photrexa (riboflavin ophthalmic solution) for progressive keratoconus with prior authorization. To get approved in New York: (1) Your cornea specialist submits prior authorization with serial topography showing progression, (2) Aetna typically decides within

How to Get Procysbi (Cysteamine Bitartrate DR) Covered by Humana in New York: Appeals, Forms & Cost-Cutting Strategies

Quick Answer: Getting Procysbi Covered by Humana in New York Procysbi (cysteamine bitartrate DR) requires prior authorization from Humana and often faces step therapy to immediate-release cysteamine first. In New York, you have 65 days to appeal denials internally, then 4 months for external review through the Department of Financial

How to Get Mepsevii (Vestronidase Alfa-vjbk) Covered by UnitedHealthcare in New York: Complete PA Guide and Appeals Strategy

Answer Box: Getting Mepsevii Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization (PA) for Mepsevii (vestronidase alfa-vjbk) across all plan types with no step therapy typically required for commercial plans. To get approved: (1) Confirm MPS VII diagnosis via β-glucuronidase enzyme assay or GUSB genetic testing, (2) Submit

How to Get Entresto (Sacubitril/Valsartan) Covered by Cigna in New York: Forms, Appeals, and Step-by-Step Guide

Answer Box: Your Fastest Path to Entresto Coverage in New York Cigna requires prior authorization for Entresto (sacubitril/valsartan) through Express Scripts. Submit your PA request with heart failure diagnosis (ICD-10 I50.22), LVEF results, and documented ACE inhibitor/ARB trial failure. If denied, you have 180 days for internal

Jakafi (Ruxolitinib) Approval with UnitedHealthcare in New York: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Jakafi (Ruxolitinib) Covered by UnitedHealthcare in New York Jakafi (ruxolitinib) requires prior authorization through OptumRx for most UnitedHealthcare plans in New York. Your fastest path to approval: (1) Have your hematologist/oncologist gather diagnosis confirmation (bone marrow biopsy, JAK2 mutation), recent labs (CBC with platelets ≥50,000/

How to Get Tagrisso (Osimertinib) Covered by Blue Cross Blue Shield in New York: Appeals Guide and State Protections

Answer Box: Getting Tagrisso Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield requires prior authorization for Tagrisso (osimertinib) in New York. To get approved: (1) Confirm EGFR mutation testing shows qualifying mutations (exon 19 deletion, L858R, T790M), (2) Have your oncologist submit PA request with

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

Blue Cross Blue Shield in New York requires prior authorization for Gattex (teduglutide) with specific criteria: confirmed short bowel syndrome with parenteral nutrition dependence (≥3 days/week), documented enteral nutrition optimization failure, baseline colonoscopy within 6 months, and GI specialist involvement. If denied, file an internal appeal within 30 days,