Topic

New York

A collection of 237 issues

Getting Opfolda (miglustat) Covered by Cigna in New York: Medical Necessity Criteria and Appeal Guide

Answer Box: Your Path to Coverage Cigna covers Opfolda (miglustat) in New York only when prescribed with Pombiliti for adults with late-onset Pompe disease (LOPD) who aren't improving on standard enzyme replacement therapy. You must be ≥18 years old, weigh >40 kg, and have documented ERT failure

How to Get Duopa Covered by Blue Cross Blue Shield in New York: Appeals Guide & Templates

Answer Box: Getting Duopa Covered by Blue Cross Blue Shield in New York Duopa requires prior authorization and is classified as a specialty medication on Blue Cross Blue Shield formularies in New York. To get coverage approved: (1) Submit a prior authorization request with documentation of advanced Parkinson's

How to Get Poteligeo (mogamulizumab-kpkc) Covered by UnitedHealthcare in New York: Prior Authorization, Appeals & Step Therapy Guide

Answer Box: Getting Poteligeo Covered by UnitedHealthcare in New York Poteligeo (mogamulizumab-kpkc) requires prior authorization from UnitedHealthcare for mycosis fungoides or Sézary syndrome treatment. You'll need documented failure of at least one prior systemic therapy and prescribing by a hematologist or oncologist. First step: Gather your CTCL staging

How to Get Evkeeza (Evinacumab) Covered by Blue Cross Blue Shield in New York: Coding, Appeals, and PA Requirements 2025

Answer Box: Quick Path to Evkeeza Coverage Getting Evkeeza (evinacumab-dgnb) covered by Blue Cross Blue Shield in New York requires three key steps: 1) Confirm your HoFH diagnosis with ICD-10 code E78.010 and genetic/clinical documentation, 2) Document failure or intolerance of maximum-dose statins, ezetimibe, and PCSK9 inhibitors, and

How to Get Ferriprox (Deferiprone) Covered by Aetna in New York: Prior Authorization, Appeals, and Step Therapy Guide

Answer Box: Getting Ferriprox Covered by Aetna in New York Aetna requires prior authorization for Ferriprox (deferiprone) with strict criteria: documented transfusional iron overload (ferritin >1000 mcg/L), diagnosis of thalassemia or sickle cell disease, and an ANC monitoring plan. Step therapy may require trying deferasirox or deferoxamine first

How to Get Onivyde (Irinotecan Liposome) Covered by Humana in New York: Prior Authorization Guide and Appeals Process

Quick Answer: Getting Onivyde Covered by Humana in New York Onivyde (irinotecan liposome) is covered by Humana Medicare Advantage for pancreatic cancer but requires prior authorization. Your fastest path to approval: Have your oncologist submit a complete PA request with diagnosis, ECOG performance status (0-1), prior therapy history, and planned

How to Get Orkambi (lumacaftor/ivacaftor) Covered by UnitedHealthcare in New York: Complete Guide to Forms, Appeals, and Approval

Answer Box: Getting Orkambi Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Orkambi (lumacaftor/ivacaftor) in New York, with specific criteria: confirmed CF diagnosis, homozygous F508del mutation, age ≥1 year, and specialist involvement. Start today by gathering genetic testing results and having your CF specialist submit the

How to Get Besponsa Covered by UnitedHealthcare in New York: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Besponsa Covered by UnitedHealthcare in New York Besponsa (inotuzumab ozogamicin) requires prior authorization from UnitedHealthcare for all commercial and Medicare plans. Your oncologist must document CD22-positive B-cell ALL, failed first-line therapy, and hepatic monitoring plans. If denied, you have 180 days for internal appeals and 4 months

Myths vs. Facts: Getting Signifor / Signifor LAR (pasireotide) Covered by Cigna in New York

Answer Box: Getting Signifor / Signifor LAR Covered by Cigna in New York Eligibility: Cigna requires prior authorization for Signifor / Signifor LAR with strict criteria: confirmed Cushing's disease or acromegaly, endocrinologist prescription, documented failure of first-generation somatostatin analogs (for acromegaly), and surgical ineligibility or post-surgical persistence. Fastest path: Submit

The Complete Checklist to Get Krystexxa (Pegloticase) Covered by Humana in New York

Answer Box: Getting Krystexxa Covered by Humana in New York Eligibility: Patients with chronic gout refractory to allopurinol and febuxostat who have G6PD testing completed and serum uric acid >6 mg/dL. Fastest Path: Submit prior authorization through Humana's provider portal with medical necessity letter documenting failed