Topic

North Carolina

A collection of 251 issues

Getting Garadacimab Covered by Blue Cross Blue Shield of North Carolina: Prior Authorization Guide and Appeals Process

Answer Box: Getting Garadacimab Covered by Blue Cross Blue Shield of North Carolina Garadacimab requires prior authorization from Blue Cross Blue Shield of North Carolina as a specialty HAE prophylaxis medication. If denied, you have strong appeal rights through Smart NC's external review process, which overturns about 50%

Myths vs. Facts: Getting Soliris (eculizumab) Covered by Cigna in North Carolina - Appeals Process and Requirements

Answer Box: Getting Soliris (eculizumab) Covered by Cigna in North Carolina Quick Facts: Cigna requires prior authorization for Soliris across all FDA-approved indications (PNH, aHUS, gMG, NMOSD). Coverage depends on meeting specific diagnostic criteria, meningococcal vaccination, and REMS enrollment. If denied, you have 180 days for internal appeals, followed by

How to Get Galafold (Migalastat) Covered by Blue Cross Blue Shield of North Carolina: Complete Guide to Forms, Appeals, and External Review

Answer Box: Getting Galafold (Migalastat) Covered by Blue Cross Blue Shield of North Carolina Eligibility: Adults with Fabry disease and a confirmed amenable GLA variant documented by genetic testing. Fastest path: Submit prior authorization through the MHK Provider Portal with genetic test results showing amenable mutation and specialist consultation notes.

How to Get Venclexta (venetoclax) Covered by Aetna (CVS Health) in North Carolina: Complete Guide to Prior Authorization, Appeals, and Coding

Quick Answer: Getting Venclexta (venetoclax) Covered by Aetna in North Carolina Venclexta requires prior authorization from Aetna (CVS Health) with step therapy requirements—typically requiring documented failure of ibrutinib and/or rituximab first. Submit your PA request through the CVS Caremark provider portal or via fax with complete clinical documentation,

Do You Qualify for Koselugo Coverage by UnitedHealthcare in North Carolina? Decision Tree & Next Steps

Answer Box: Quick Qualification Check Getting Koselugo (selumetinib) covered by UnitedHealthcare in North Carolina: You'll likely qualify if your child (age 2-18) has confirmed NF1 with symptomatic, inoperable plexiform neurofibromas documented by MRI. First step: Gather baseline LVEF testing, ophthalmologic exam results, and surgical consultation notes confirming inoperability.

How to Get Fintepla (Fenfluramine) Covered by Aetna CVS Health in North Carolina: Appeals Timeline and Medical Necessity Templates

Answer Box: Getting Fintepla Covered by Aetna CVS Health in North Carolina Fastest Path: 1) Ensure REMS enrollment and baseline echocardiogram documentation, 2) Submit prior authorization with evidence of failed standard antiseizure medications (minimum 2), and 3) Include neurologist consultation confirming Dravet syndrome or Lennox-Gastaut syndrome diagnosis. If denied, appeal

Getting Rylaze Approved by Humana in North Carolina: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Started Today Rylaze (asparaginase erwinia chrysanthemi) requires prior authorization from Humana, with approval contingent on documented Grade 2-4 hypersensitivity to E. coli asparaginase. The fastest path: (1) Gather complete allergy documentation and ALL/LBL diagnosis records, (2) Submit PA request through Humana's provider portal with

How to Get Cresemba (Isavuconazole) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Cresemba Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Cresemba (isavuconazole) in North Carolina through OptumRx. You'll need: confirmed invasive aspergillosis (B44.0) or mucormycosis (B46.x) diagnosis, documentation that voriconazole failed/can't be used, and infectious disease specialist consultation.

How to Get Waylivra (Volanesorsen) Covered by Aetna in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Waylivra Covered by Aetna in North Carolina Waylivra (volanesorsen) is not FDA-approved in the US, making Aetna coverage extremely difficult but not impossible. For familial chylomicronemia syndrome (FCS), you'll need genetic confirmation, documented triglyceride levels ≥880 mg/dL, and failure of standard therapies. Your fastest

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

Answer Box: Getting Helixate Covered by Cigna in North Carolina Helixate requires prior authorization from Cigna and is typically non-formulary, requiring step therapy documentation. Start immediately with your hematologist to complete the Cigna Hemophilia Factor VIII Prior Authorization Form via CoverMyMeds or fax. If denied, you have 180 days for