Topic

New York

A collection of 420 issues

Renewing Tepezza (Teprotumumab) Approval with Aetna CVS Health in New York: Complete Guide to Documentation and Timelines

Answer Box: Renewing Tepezza Coverage Most Aetna CVS Health plans limit Tepezza to one 8-infusion course per lifetime. Renewal beyond 8 doses requires exceptional documentation showing unmet clinical need plus peer-reviewed evidence supporting extended treatment. Start renewal requests 2-4 weeks before your final scheduled infusion. If denied, New York residents

How to Get Rebif (Interferon Beta-1a) Covered by Humana in New York: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Rebif Covered by Humana in New York Most Humana plans require prior authorization for Rebif (interferon beta-1a). Submit via Humana's Medicare Prescription Drug Coverage Determination form (fax: 877-486-2621) or provider portal. Include MS diagnosis, prior DMT failures, MRI/relapse history, and medical necessity letter. Standard

How to Get Retevmo (Selpercatinib) Covered by Humana in New York: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Retevmo Covered by Humana in New York Retevmo (selpercatinib) requires prior authorization under Humana Medicare plans and may be non-formulary depending on your specific plan. To get coverage in New York: 1) Have your oncologist submit a prior authorization request with RET mutation testing results and medical

How to Get Zokinvy (lonafarnib) Covered by UnitedHealthcare in New York: Complete Appeal Guide

Quick Answer: Getting Zokinvy Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Zokinvy (lonafarnib) with specific genetic testing requirements. For HGPS patients, you need confirmed diagnosis only. For progeroid laminopathies, you must document heterozygous LMNA mutation with progerin-like protein accumulation OR homozygous/compound heterozygous ZMPSTE24 mutations. Submit

Renewing Hetlioz (Tasimelteon) Approval with UnitedHealthcare in New York: Complete 2025 Timeline and Documentation Guide

Answer Box: Hetlioz Renewal with UnitedHealthcare in New York UnitedHealthcare requires annual prior authorization renewal for Hetlioz (tasimelteon), with documentation of positive clinical response. Submit renewal 30 days before expiration via the UnitedHealthcare Provider Portal with updated sleep diaries showing continued benefit. If denied, file internal appeal within 180 days,

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

Answer Box: Getting Zokinvy (lonafarnib) Covered by Aetna (CVS Health) in New York Zokinvy requires prior authorization from Aetna (CVS Health) with genetic confirmation of HGPS or qualifying progeroid laminopathy, age ≥12 months, BSA ≥0.39 m², and specialist management. Standard decisions take 15 business days; expedited reviews complete within

How to Get StrataGraft Covered by UnitedHealthcare in New York: Prior Authorization Guide with Appeals Process and Documentation Requirements

Quick Answer: Getting StrataGraft Approved by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for StrataGraft (allogeneic cultured keratinocytes & fibroblasts in murine collagen-dsat) under the medical benefit, not pharmacy. Submit via the UHC Provider Portal with burn depth documentation, TBSA calculations, and proof of failed standard therapies. Standard decisions

Renewing Therakos CELLEX Photopheresis Coverage with UnitedHealthcare in New York: Timeline, Documentation & Appeal Options

Answer Box: Fast Track to Renewal Therakos CELLEX photopheresis renewal with UnitedHealthcare requires prior authorization renewal before your current approval expires. Submit renewal requests 10-14 days before expiration via the UHC provider portal with updated clinical documentation showing treatment response. For CTCL or GVHD patients, include response assessments, lab monitoring

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

Answer Box: Getting Bylvay (odevixibat) Covered by Aetna (CVS Health) in New York Bylvay (odevixibat) requires prior authorization from Aetna (CVS Health) and is typically non-formulary, requiring a medical exception. The fastest path: Have a pediatric hepatologist or gastroenterologist submit a complete PA packet through Aetna's provider portal

Aetna (CVS Health) Coverage Criteria for Ultomiris (ravulizumab) in New York: What Counts as "Medically Necessary"?

Answer Box: Getting Ultomiris Covered by Aetna (CVS Health) in New York Ultomiris (ravulizumab) requires prior authorization from Aetna (CVS Health) for all FDA-approved indications (PNH, aHUS, anti-AChR+ generalized myasthenia gravis, and NMOSD). Coverage requires meeting diagnosis-specific criteria, meningococcal vaccination, and documentation of clinical necessity. Quick start: 1) Verify your