Topic

New York

A collection of 498 issues

Myths vs. Facts: Getting Naglazyme (Galsulfase) Covered by Blue Cross Blue Shield in New York - Complete Guide

Answer Box: Getting Naglazyme Covered by Blue Cross Blue Shield in New York Yes, Blue Cross Blue Shield plans in New York can cover Naglazyme (galsulfase) for MPS VI, but prior authorization is required. The fastest path to approval: 1) Confirm MPS VI diagnosis with enzyme assay and genetic testing,

How to Get Vyndaqel/Vyndamax (Tafamidis) Covered by Aetna CVS Health in New York: Complete Prior Authorization Guide

Answer Box: Getting Vyndaqel/Vyndamax Covered by Aetna CVS Health in New York Aetna CVS Health requires prior authorization for tafamidis (Vyndaqel/Vyndamax) with annual reauthorization. Submit via Aetna provider portal or CVS Specialty Pharmacy (fax: 1-866-249-6155) with confirmed ATTR-CM diagnosis, cardiology oversight, and NYHA class documentation. If denied, appeal

How to Get Lamzede (velmanase alfa-tycv) Covered by Blue Cross Blue Shield in New York: Timeline, Forms & Appeals Guide

Answer Box: Quick Path to Lamzede Coverage Blue Cross Blue Shield in New York requires prior authorization for Lamzede (velmanase alfa-tycv). Submit through Availity Essentials portal with confirmed alpha-mannosidosis diagnosis (enzyme activity <10% normal), genetic testing results, and specialist prescription. Standard approval takes 5-15 business days; expedited review available

How to Get Opdivo (nivolumab) Covered by Blue Cross Blue Shield in New York: Prior Authorization, Appeals, and Step Therapy Guide

Answer Box: Getting Opdivo Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield of New York requires prior authorization for Opdivo (nivolumab), typically approving coverage for FDA-labeled oncology indications when submitted with complete clinical documentation. The fastest path: have your oncologist submit a PA request through

Getting Elfabrio (Pegunigalsidase Alfa-iwxj) Approved by Cigna in New York: Timeline, Forms & Appeal Process

Answer Box: Fast Track to Elfabrio Approval Getting Elfabrio (pegunigalsidase alfa-iwxj) covered by Cigna in New York requires prior authorization with confirmed Fabry disease diagnosis and specialist oversight. Submit complete documentation via CoverMyMeds or Cigna provider portal within 2-5 business days for standard review. If denied, you have 180 days

How to Get Poteligeo (mogamulizumab-kpkc) Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Poteligeo Covered by Blue Cross Blue Shield in New York Poteligeo (mogamulizumab-kpkc) requires prior authorization from Blue Cross Blue Shield plans in New York for relapsed/refractory mycosis fungoides or Sézary syndrome after at least one prior systemic therapy. Your fastest path: Verify you have a BCBS

How to Get Therakos CELLEX Photopheresis Covered by Cigna in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Cigna Coverage for Therakos CELLEX in New York Cigna requires prior authorization for Therakos CELLEX photopheresis (CPT 36522) as a medical benefit for FDA-approved indications including cutaneous T-cell lymphoma (CTCL) and steroid-refractory graft-versus-host disease (GVHD). Coverage mandates documented progressive disease after failed standard therapies and specialist oversight.

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

Quick Answer: Getting BCBS Coverage for Ozempic/Mounjaro in New York Blue Cross Blue Shield requires prior authorization for Ozempic (semaglutide) and Mounjaro (tirzepatide) when prescribed for type 2 diabetes. The fastest path to approval: Work with your doctor to document your type 2 diabetes diagnosis, failed trials with metformin

How to Get Ferriprox (deferiprone) Approved by UnitedHealthcare in New York: Complete Prior Authorization Guide

Quick Answer: Getting Ferriprox Approved in New York Ferriprox (deferiprone) requires prior authorization from UnitedHealthcare for transfusional iron overload. In New York, submit your request with documented iron overload (ferritin >1000 ng/mL, LIC >3.2 mg/g), underlying diagnosis (thalassemia, sickle cell), and ANC monitoring plan via

How to Get Brineura (Cerliponase Alfa) Covered by Aetna (CVS Health) in New York: Complete Appeals Guide

Answer Box: Getting Brineura Covered by Aetna (CVS Health) in New York Aetna requires prior authorization for Brineura (cerliponase alfa) under the medical benefit for pediatric CLN2 patients ≥3 years with confirmed TPP1 deficiency and motor function scores ≥1. Submit via neurologist with diagnosis confirmation, CLN2 Clinical Rating Scale scores,