Topic

North Carolina

A collection of 430 issues

Work With Your Doctor to Get Xembify (Immune Globulin, SC) Approved by Humana in North Carolina

Quick Answer: Getting Xembify Approved by Humana in North Carolina Xembify requires prior authorization from Humana with documented primary immunodeficiency diagnosis and lab evidence (low IgG levels, recurrent infections). Your doctor must submit clinical documentation including infection history, immunoglobulin levels, and prior therapy trials. Start by scheduling a visit with

How to Get Elfabrio (pegunigalsidase alfa-iwxj) Covered by Aetna CVS Health in North Carolina: Requirements, Appeals & Timeline

Answer Box: Getting Elfabrio Covered by Aetna CVS Health in North Carolina Eligibility: Adults 18+ with confirmed Fabry disease via enzyme assay or genetic testing. Fastest path: Submit prior authorization with quantitative enzyme levels, clinical notes showing organ involvement, and medical necessity letter. First step: Have your provider submit PA

If Qinlock (Ripretinib) Isn't Approved by Cigna in North Carolina: Formulary Alternatives & Exception Paths

Answer Box: Getting GIST Treatment When Qinlock Isn't Approved If Cigna denies Qinlock (ripretinib) in North Carolina, you have three main paths: try formulary alternatives like regorafenib or sunitinib first, request a formulary exception with clinical justification, or appeal through North Carolina's external review system via

How to Get Humate-P Covered by Blue Cross Blue Shield in North Carolina: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Humate-P Covered in North Carolina Humate-P requires prior authorization from Blue Cross Blue Shield of North Carolina and is typically placed on Tier 4-5 specialty drug tiers. The fastest path to approval: (1) Have your hematologist submit a comprehensive prior authorization request documenting your VWD subtype or

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

Answer Box: Getting Gilenya Covered by Cigna in North Carolina Eligibility: Gilenya requires prior authorization from Cigna for relapsing multiple sclerosis in patients 10+ years old. Your neurologist must submit baseline testing (EKG, eye exam, labs) and first-dose monitoring plans through CoverMyMeds portal or fax to 1-866-873-8279. Fastest Path: Complete

Myths vs. Facts: Getting Hemgenix (Etranacogene Dezaparvovec) Covered by Aetna (CVS Health) in North Carolina

Answer Box: Getting Hemgenix Covered by Aetna (CVS Health) in North Carolina Eligibility: Adults 18+ with severe/moderately severe hemophilia B (≤2% Factor IX activity), 150+ exposure days of Factor IX prophylaxis, and no inhibitor history. Fastest path: Submit complete prior authorization through CVS Specialty with all lab work, bleeding

How to Get Crysvita (burosumab) Covered by Aetna (CVS Health) in North Carolina: Complete PA Guide with Appeals Timeline

Answer Box: Getting Crysvita (burosumab) Covered by Aetna (CVS Health) in North Carolina Crysvita requires prior authorization from Aetna (CVS Health) for all members. To get approved, you need: genetic testing showing PHEX mutation or elevated FGF23 levels, radiographic evidence of bone disease, and a specialist prescriber experienced in metabolic

How to Get Ocrevus (Ocrelizumab) Covered by Blue Cross Blue Shield North Carolina: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Ocrevus Covered in North Carolina To get Ocrevus (ocrelizumab) covered by Blue Cross Blue Shield North Carolina, you'll need prior authorization through their specialty pharmacy network. Start today by having your neurologist submit a PA request via CoverMyMeds.com with your MS diagnosis, prior therapy

How to Get Raxone (Idebenone) Covered by Humana in North Carolina: Appeals Guide with Forms and Timelines

Answer Box: Getting Raxone (Idebenone) Covered by Humana in North Carolina Fast path to approval: Submit a formulary exception request with comprehensive medical necessity documentation showing failed alternatives. If denied, appeal within 65 days, then use North Carolina's Smart NC external review within 120 days of final denial.

Getting Lutathera (Lutetium Lu-177 Dotatate) Covered by Humana in North Carolina: Complete Appeal Guide with Forms and Timelines

Answer Box: Your Fastest Path to Coverage Getting Lutathera covered by Humana in North Carolina requires: SSTR-positive imaging (Ga-68 DOTATATE PET/CT preferred), pathology confirming well-differentiated NET, and documented progression despite somatostatin analog therapy. Start today by: requesting your complete medical records and SSTR imaging reports from your oncologist. Timeline: