Topic

New York

A collection of 420 issues

Getting Joenja (Leniolisib) Covered by Blue Cross Blue Shield in New York: Complete Guide to Prior Authorization, Appeals, and Approval

Answer Box: Quick Start Guide Yes, Blue Cross Blue Shield plans in New York can cover Joenja (leniolisib) for APDS, but prior authorization is required. The fastest path to approval: (1) Have your immunologist submit a PA request through the BCBS provider portal with genetic confirmation of APDS (PIK3CD/PIK3R1

Takhzyro (lanadelumab-flyo) Approval with Humana in New York: Answers to the Most Common Questions

Answer Box: Getting Takhzyro Covered by Humana in New York Takhzyro (lanadelumab-flyo) requires prior authorization from Humana for hereditary angioedema (HAE) prophylaxis. You'll need confirmed HAE type I/II diagnosis with lab documentation, specialist prescriber, and evidence of prior therapy failures. If denied, New York residents can file

How to Get Jakafi (ruxolitinib) Covered by Cigna in New York: Prior Authorization Guide and Appeals Process

Answer Box: Quick Path to Jakafi Coverage Getting Jakafi (ruxolitinib) covered by Cigna in New York requires prior authorization with specific documentation. For myelofibrosis, you'll need diagnosis confirmation and symptom documentation. For polycythemia vera, you must show hydroxyurea failure or intolerance. Submit through Cigna's provider portal

How to Get Gamifant (Emapalumab-lzsg) Covered by UnitedHealthcare in New York: Prior Authorization, Appeals, and Medical Necessity Requirements

Quick Answer: To get Gamifant (emapalumab-lzsg) covered by UnitedHealthcare in New York, you need prior authorization showing: (1) confirmed primary HLH meeting HLH-2004 criteria, (2) failure/intolerance of conventional therapy (dexamethasone + etoposide), and (3) FDA-label dosing plan. Submit through the UnitedHealthcare Provider Portal with complete diagnostic documentation. If denied, file

How to Get Gamifant (Emapalumab-lzsg) Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Gamifant Covered in New York Blue Cross Blue Shield plans in New York cover Gamifant (emapalumab-lzsg) for primary HLH with prior authorization. The fastest path: (1) Submit PA with complete HLH-2004 diagnostic criteria documentation and proof of conventional therapy failure, (2) Use Empire/Excellus provider portal with

How to Get Oxlumo (lumasiran) Covered by UnitedHealthcare in New York: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Oxlumo Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Oxlumo (lumasiran) with genetic confirmation of PH1, elevated urinary oxalate levels, and specialist prescriber documentation. Submit through the UHC provider portal with complete clinical records. If denied, you have 30 days for internal appeal, then

How to Get Trikafta Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Trikafta Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield of New York (Anthem BCBSNY) requires prior authorization for Trikafta, including genetic testing confirming F508del or other eligible CFTR mutations, CF diagnosis documentation, and specialist attestation. Submit PA through Availity Essentials with complete

The Complete Requirements Checklist to Get Imbruvica (ibrutinib) Covered by Blue Cross Blue Shield in New York

Answer Box: Getting Imbruvica (ibrutinib) Covered by Blue Cross Blue Shield in New York Prior authorization is required for Imbruvica (ibrutinib) by all BCBS plans in New York. Submit through your plan's provider portal with diagnosis confirmation, prior therapy documentation, and NCCN guideline support. If denied, New York&

Get Koselugo (Selumetinib) Covered by Aetna CVS Health in New York: Complete Guide to Prior Authorization and Appeals

Answer Box: Quick Path to Approval Koselugo (selumetinib) requires prior authorization from Aetna CVS Health for pediatric patients ≥2 years with NF1 and symptomatic, inoperable plexiform neurofibromas. Your prescriber submits the PA with baseline LVEF (echocardiogram) and ophthalmologic evaluation results. Standard decisions take 30-45 days; expedited reviews complete within 72

Get Photrexa Covered by UnitedHealthcare in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Get Photrexa Covered by UnitedHealthcare in New York UnitedHealthcare covers FDA-approved Photrexa (riboflavin ophthalmic solution) for progressive keratoconus with prior authorization, but only for epithelium-off procedures using the iLink® system. In New York, if denied, you have strong appeal rights through the Department of Financial Services with expedited