Topic

New York

A collection of 420 issues

How to Get Helixate (Antihemophilic Factor, rFVIII) Covered by Blue Cross Blue Shield in New York: Complete PA and Appeals Guide

Answer Box: Getting Helixate Covered in New York Helixate (antihemophilic factor, rFVIII) requires prior authorization from Blue Cross Blue Shield in New York. Submit PA requests via the Availity ICR portal or fax 1-844-493-9206. If denied, file an internal appeal within 65 days, then pursue external review through NY Department

How to Get Fabrazyme (agalsidase beta) Covered by Blue Cross Blue Shield in New York: Complete PA and Appeals Guide

Answer Box: Getting Fabrazyme Covered by BCBS in New York Blue Cross Blue Shield plans in New York require prior authorization for Fabrazyme (agalsidase beta). Success depends on three key elements: confirmed Fabry disease diagnosis via genetic testing or enzyme assay, prescription by a qualified specialist (geneticist, nephrologist, cardiologist), and

How to Get Bylvay (odevixibat) Covered by UnitedHealthcare in New York: Prior Authorization, Appeals, and Alternative Paths

Answer Box: Getting Bylvay Covered by UnitedHealthcare in New York Bylvay (odevixibat) requires prior authorization from UnitedHealthcare in New York. Most plans use either a Notification policy (lighter requirements) or Medical Necessity policy (requires failure of 2+ conventional cholestatic treatments first). If denied, New York offers strong external appeal protections

If Takhzyro Isn't Approved by Cigna in New York: Formulary Alternatives & Exception Paths

Answer Box: When Cigna Denies Takhzyro for HAE Prophylaxis If Cigna denies Takhzyro (lanadelumab-flyo) for hereditary angioedema (HAE) prophylaxis in New York, you have three main options: try formulary alternatives like Haegarda (subcutaneous C1-INH) or Orladeyo (oral berotralstat), request a step therapy exception with clinical justification, or file an internal

How to Get Joenja (leniolisib) Approved by Cigna in New York: Complete Prior Authorization Guide with Appeals Timeline

Answer Box: Getting Joenja (leniolisib) Covered by Cigna in New York Joenja (leniolisib) requires prior authorization through Cigna's specialty pharmacy benefit, managed by Express Scripts/Accredo, with standard decisions in 5 business days or 24 hours for urgent cases. Key requirements include genetic confirmation of APDS (PIK3CD or

Work With Your Doctor to Get Alecensa (alectinib) Approved by UnitedHealthcare in New York: Complete Provider Collaboration Guide

Answer Box: Your Path to Alecensa Coverage Getting Alecensa (alectinib) approved by UnitedHealthcare in New York requires teamwork with your oncologist. The fastest path: confirm your ALK-positive NSCLC diagnosis is documented, gather complete treatment history, and have your provider submit prior authorization with molecular pathology reports. If denied, New York

How to Get Xembify Covered by UnitedHealthcare in New York: Prior Authorization, Appeals & Cost Assistance Guide

Answer Box: To get Xembify covered by UnitedHealthcare in New York, you'll need prior authorization through OptumRx. Submit via the UHC Provider Portal with diagnosis documentation (primary immunodeficiency), prior IVIG trials, and dosing justification. If denied, file an internal appeal within 180 days, then request external review through

How to Get Arcalyst (Rilonacept) Approved by Cigna in New York: Complete Timeline & Appeal Guide

Answer Box: Getting Arcalyst (Rilonacept) Covered by Cigna in New York Cigna requires prior authorization for Arcalyst (rilonacept) with specialist prescription and specific clinical documentation. Standard approval takes 15 business days; urgent requests are processed within 72 hours. If denied, you have 180 days for internal appeals and 4 months

How to Get Haegarda (C1-esterase inhibitor, SC) Covered by Cigna in New York: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Haegarda Covered by Cigna in New York Cigna requires prior authorization for Haegarda with specialist diagnosis, lab confirmation (low C4), and documented HAE attack history. Submit through your HAE specialist using Cigna's C1-esterase inhibitor PA form. If denied, you have 180 days for internal appeals

How to Get Venclexta (venetoclax) Covered by Humana in New York: Prior Authorization, Appeals, and TLS Monitoring Guide

Answer Box: Getting Venclexta Covered by Humana in New York Venclexta (venetoclax) requires prior authorization from Humana due to its high cost (~$15,620/month) and tumor lysis syndrome (TLS) risks. Your oncologist must submit documentation including confirmed CLL/AML diagnosis, TLS monitoring plan with baseline labs, and justification if