Topic

North Carolina

A collection of 430 issues

Do You Qualify for Tavalisse Coverage by Aetna CVS Health in North Carolina? Decision Tree & Next Steps

Answer Box: Quick Path to Tavalisse Coverage Yes, you likely qualify if you have chronic ITP (platelets <100,000 for ≥12 months), failed corticosteroids/IVIG, have platelets <50,000 or bleeding symptoms, and see a hematologist. Fastest approval: Submit Aetna's PA through Availity portal with complete

Get Takhzyro (Lanadelumab-flyo) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization Guide with Forms and Appeal Scripts

Answer Box: Getting Takhzyro Approved by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Takhzyro (lanadelumab-flyo) with specific criteria: confirmed HAE diagnosis with C1-INH deficiency, baseline attack rate ≥1 per 4 weeks, and prescribing by an allergist/immunologist. Submit through the UnitedHealthcare Provider Portal with lab results, attack documentation,

How to Get Sylvant (siltuximab) Covered by Aetna (CVS Health) in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Sylvant (siltuximab) Covered by Aetna (CVS Health) in North Carolina Sylvant requires prior authorization from Aetna (CVS Health) for idiopathic multicentric Castleman disease (iMCD). The fastest path: ensure your oncologist submits complete documentation showing HIV-negative/HHV-8-negative status, multicentric pathology, and active disease. If denied, North Carolina'

How to Get Natpara (Parathyroid Hormone) Approved by UnitedHealthcare in North Carolina: Complete Timeline & Appeals Guide

Answer Box: Getting Natpara Approved by UnitedHealthcare in North Carolina Important Update: Takeda permanently discontinued Natpara manufacturing in December 2024, with the Special Use Program ending December 31, 2025. New patient approvals are extremely unlikely due to lack of commercial supply. For existing patients: UnitedHealthcare typically requires 1-15 business days

How to Get Tavalisse (fostamatinib) Covered by Humana in North Carolina: Complete Appeals Guide with Forms and Scripts

Answer Box: Getting Tavalisse Covered by Humana in North Carolina Tavalisse (fostamatinib) requires prior authorization and formulary exception from Humana in North Carolina. Most approvals need documented failure of steroids, IVIG, and at least one TPO receptor agonist, plus hematologist prescription. First step today: Have your hematologist gather treatment history

Myths vs. Facts: Getting Cometriq (Cabozantinib) Covered by Blue Cross Blue Shield in North Carolina - Complete Prior Authorization Guide

Answer Box: Getting Cometriq Covered by Blue Cross Blue Shield in North Carolina Eligibility: Blue Cross Blue Shield of North Carolina covers Cometriq (cabozantinib capsules) as a specialty drug requiring prior authorization for FDA-approved medullary thyroid carcinoma. Fastest path: Your oncologist submits a PA through the Prime Therapeutics portal with

How Long Does It Take to Get Cresemba (Isavuconazole) Approved by Cigna in North Carolina? Complete Timeline & Appeal Guide

Answer Box: Quick Start Guide Getting Cresemba (isavuconazole) approved by Cigna in North Carolina typically takes 2-5 business days with complete documentation. For invasive aspergillosis, you'll need to try voriconazole first (step therapy) unless contraindicated. If denied, North Carolina offers external review through Smart NC with 45-day standard

How Long Does It Take to Get Xyrem (Sodium Oxybate) Approved by UnitedHealthcare in North Carolina? Complete Timeline & Appeals Guide

Quick Answer: Xyrem Approval Timeline in North Carolina Getting Xyrem (sodium oxybate) approved by UnitedHealthcare in North Carolina typically takes 1-15 business days for the prior authorization decision, plus 1-3 days for REMS enrollment. The fastest path: ensure both you and your prescriber complete REMS enrollment first, then have your

How to Get Lutathera (Lutetium Lu-177 Dotatate) Covered by Blue Cross Blue Shield in North Carolina: Complete Guide with Forms and Appeals

Answer Box: Getting Lutathera Covered by Blue Cross Blue Shield in North Carolina Blue Cross Blue Shield of North Carolina covers Lutathera (lutetium Lu-177 dotatate) for somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors when medical necessity criteria are met. Fastest path to approval: Submit prior authorization with complete documentation including SSTR-positive imaging,

How to Get Abecma (idecabtagene vicleucel) Approved by Cigna in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Abecma Covered by Cigna in North Carolina To get Abecma (idecabtagene vicleucel) CAR-T therapy approved by Cigna in North Carolina, you need: (1) documentation of ≥2 prior therapy lines including an IMiD, proteasome inhibitor, and anti-CD38 antibody, (2) treatment at a Cigna-approved CAR-T center, and (3) prior