Topic

North Carolina

A collection of 246 issues

How to Get Imbruvica (ibrutinib) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Imbruvica Covered by UnitedHealthcare in North Carolina Most UnitedHealthcare members in North Carolina can get Imbruvica (ibrutinib) covered through OptumRx's prior authorization process. The key steps: verify your diagnosis meets medical necessity criteria (CLL, SLL, or Waldenström macroglobulinemia), gather comprehensive clinical documentation, and submit the

Getting Orkambi (lumacaftor/ivacaftor) Covered by Cigna in North Carolina: Complete Guide to Prior Authorization, Appeals, and Templates

Quick Answer: Getting Orkambi Covered by Cigna in North Carolina Cigna requires prior authorization for Orkambi (lumacaftor/ivacaftor) with proof of homozygous F508del mutation and CF specialist prescription. If denied, you have 180 days for internal appeals, then can request external review through North Carolina's Smart NC program.

How to Get Amondys 45 (Casimersen) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Amondys 45 Covered by Aetna CVS Health in North Carolina Aetna CVS Health requires prior authorization for Amondys 45 (casimersen) with strict documentation: genetic testing confirming exon 45-amenable DMD mutation, age under 14, specialist prescription, and detailed monitoring plan. If denied, North Carolina residents can appeal internally

How to Get Skyrizi (Risankizumab) Covered by Cigna in North Carolina: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Skyrizi (risankizumab) covered by Cigna in North Carolina requires prior authorization through Express Scripts/Accredo. Submit via CoverMyMeds portal with clinical documentation showing disease severity (PASI ≥10 or BSA ≥10% for psoriasis) and prior systemic therapy failures. If denied, appeal through Cigna's internal process, then

Renewing Xyrem (Sodium Oxybate) Approval with Humana in North Carolina: 2025 Requirements and Timeline

Quick Answer: Xyrem Renewal with Humana in North Carolina Start your Xyrem renewal 30-45 days before expiration. Humana requires updated clinical documentation, evidence of continued medical necessity, and REMS program compliance. If denied, you have 65 days to appeal through Medicare's federal process (not North Carolina's

How to Get Raxone (Idebenone) Covered by Aetna CVS Health in North Carolina: Prior Authorization, Appeals & Step-by-Step Guide

Answer Box: Getting Raxone Covered by Aetna CVS Health in North Carolina Raxone (idebenone) is not FDA-approved in the US, making Aetna CVS Health coverage extremely challenging. You'll need a formulary exception request with comprehensive medical necessity documentation from your prescriber. Start by having your doctor submit a

Myths vs. Facts: Getting Voydeya (danicopan) Covered by Aetna CVS Health in North Carolina

Answer Box: Getting Voydeya (danicopan) Covered by Aetna CVS Health in North Carolina Eligibility: Voydeya requires prior authorization from Aetna CVS Health with documented PNH diagnosis via flow cytometry, evidence of extravascular hemolysis on C5 inhibitor therapy, and specialist prescriber attestation. Fastest path: Have your hematologist submit complete PA documentation

Getting Luxturna (Voretigene Neparvovec) Covered by Aetna CVS Health in North Carolina: Complete Guide

Answer Box: Getting Luxturna Covered in North Carolina Eligibility: Aetna CVS Health covers Luxturna (voretigene neparvovec) for patients with confirmed biallelic RPE65 mutations causing retinal dystrophy. Prior authorization is required for all plans. Fastest path: 1) Obtain genetic testing confirming RPE65 mutations, 2) Submit comprehensive PA request with clinical documentation

How to Get Humira (Adalimumab) Covered by UnitedHealthcare in North Carolina: Complete Coding & Appeals Guide

Answer Box: Quick Path to Humira Coverage Getting Humira (adalimumab) covered by UnitedHealthcare in North Carolina requires prior authorization through OptumRx. Most denials stem from incomplete documentation or step therapy requirements favoring adalimumab biosimilars. Your fastest path: 1) Submit PA with correct ICD-10 codes and failed biosimilar trials, 2) If

How to Get Vyondys 53 (Golodirsen) Covered by UnitedHealthcare in North Carolina: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Vyondys 53 Covered by UnitedHealthcare in North Carolina Eligibility: Patients with Duchenne muscular dystrophy and confirmed exon 53-amenable mutations who remain ambulatory without assistive devices. Fastest Path: Submit prior authorization through UnitedHealthcare Provider Portal with genetic testing results, ambulatory status documentation, and complete renal monitoring plan. UnitedHealthcare