Topic

North Carolina

A collection of 251 issues

Myths vs. Facts: Getting Orfadin (nitisinone) Covered by Humana in North Carolina

Answer Box: Fast Track to Orfadin Coverage Myth: Your doctor's prescription guarantees coverage. Fact: Humana requires prior authorization with specific documentation for Orfadin (nitisinone). In North Carolina, you have strong appeal rights through Smart NC external review if initially denied. Fastest path: Have your prescriber submit PA with

Renewing Xembify Approval with UnitedHealthcare in North Carolina: 2025 Requirements and Timeline

Answer Box: Renewing Xembify Coverage with UnitedHealthcare in North Carolina Start your Xembify renewal 60-90 days before expiration. UnitedHealthcare typically requires annual reauthorization with updated IgG levels, infection documentation, and clinical response evidence. Submit through the UnitedHealthcare Provider Portal with current labs and provider attestation. If coverage lapses, request expedited

How to Get Firdapse (Amifampridine) Covered by UnitedHealthcare in North Carolina: Complete Guide with Appeals Process and State Protections

Answer Box: Getting Firdapse Covered in North Carolina UnitedHealthcare requires prior authorization for Firdapse (amifampridine) in North Carolina. Your fastest path to approval: (1) Have your neurologist submit a complete PA request with confirmed LEMS diagnosis (EMG showing >60% increment, P/Q-type VGCC antibodies), clinical documentation of functional impairment,

How to Get Brensocatib (BRINSUPRI) Covered by Blue Cross Blue Shield of North Carolina: Complete Prior Authorization Guide 2025

Answer Box: Getting Brensocatib (BRINSUPRI) Covered in North Carolina To get Brensocatib (BRINSUPRI) covered by Blue Cross Blue Shield of North Carolina: Submit a prior authorization request documenting failed macrolide therapy (azithromycin/clarithromycin) and airway clearance treatment, plus at least 2 exacerbations requiring antibiotics in the past year (1 for

How to Get Alprolix Covered by UnitedHealthcare in North Carolina: Prior Authorization Forms, Appeals, and State Resources

Answer Box: Getting Alprolix Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Alprolix through OptumRx, typically requiring hematologist prescribing, documented hemophilia B diagnosis, and evidence of failed standard factor IX therapy. Submit PA via the UnitedHealthcare Provider Portal, prepare for potential step therapy requirements, and if denied,

How to Get Opdivo (nivolumab) Covered by UnitedHealthcare in North Carolina: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Opdivo Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Opdivo (nivolumab) and may apply step therapy requirements. If denied, you can appeal through UnitedHealthcare's internal process, then request external review through North Carolina's Smart NC program within 120 days. Your

Resources to Get Nucala (Mepolizumab) Approved with Humana in North Carolina: Complete Forms, Portals & Appeals Guide

Answer Box: Getting Nucala Covered by Humana in North Carolina Nucala (mepolizumab) requires prior authorization from Humana with documented blood eosinophil count ≥150 cells/μL and severe asthma despite optimized inhaled therapy. Start here: 1) Download the current PA form from Prescriber Point or submit electronically via CoverMyMeds, 2) Gather

How to Get Cometriq (Cabozantinib) Covered by Cigna in North Carolina: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Cometriq (Cabozantinib) Covered by Cigna in North Carolina Cometriq (cabozantinib) requires prior authorization through Cigna and must be filled at Accredo specialty pharmacy for coverage. Your oncologist submits clinical documentation proving medical necessity for metastatic medullary thyroid carcinoma. If denied, you have 180 days for internal appeals,

Aetna (CVS Health) Coverage Criteria for Onivyde (Irinotecan Liposome) in North Carolina: What Counts as "Medically Necessary"?

Answer Box: Getting Onivyde Covered by Aetna (CVS Health) in North Carolina Aetna requires prior authorization for Onivyde (irinotecan liposome) with strict medical necessity criteria. You must have metastatic pancreatic adenocarcinoma, ECOG performance status 0-1, adequate biliary drainage, and documented failure of gemcitabine-based therapy. Submit PA via Aetna's

Get Xenpozyme (olipudase alfa-rpcp) Covered by Cigna in North Carolina: Complete Prior Authorization Guide and Appeals Process

Answer Box: Quick Path to Approval Xenpozyme (olipudase alfa-rpcp) requires prior authorization from Cigna in North Carolina. To get approved: (1) Confirm ASMD diagnosis with genetic testing and enzyme assay, (2) Have a metabolic specialist submit the PA request through CoverMyMeds or Cigna's portal with required documentation, (3)