Topic

North Carolina

A collection of 504 issues

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

Answer Box: Getting Gamifant (Emapalumab) Covered by Aetna CVS Health in North Carolina Fastest path to approval: Submit prior authorization through CVS Caremark portal with documented primary HLH diagnosis (HLH-2004 criteria), proof of conventional therapy failure (etoposide + dexamethasone), and hematologist medical necessity letter. If denied, use North Carolina's

How to Get Strensiq (Asfotase Alfa) Covered by Blue Cross Blue Shield North Carolina: Complete Forms, Appeals, and State Resources Guide

Answer Box: Getting Strensiq Covered in North Carolina Blue Cross Blue Shield North Carolina requires prior authorization for Strensiq (asfotase alfa) through their MHK Provider Portal via Blue e. Submit clinical documentation confirming pediatric-onset hypophosphatasia with genetic/biochemical evidence. If denied, file internal appeals within 180 days, then request Smart

How to Get Myozyme (Alglucosidase Alfa) Covered by Cigna in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Fastest Path to Myozyme Coverage To get Myozyme (alglucosidase alfa) covered by Cigna in North Carolina, you need: (1) confirmed Pompe disease diagnosis with GAA enzyme testing and/or genetic results, (2) prescription from a metabolic/neuromuscular specialist, and (3) prior authorization submission via Cigna's provider

How to Get Sumavel DosePro (Sumatriptan Injection, Needle-Free) Covered by Humana in North Carolina: Complete Renewal Guide

Quick Answer: Renewing Sumavel DosePro Coverage with Humana in North Carolina Important: Sumavel DosePro was discontinued in 2018, but you can still get coverage for generic sumatriptan injection auto-injectors through Humana. Start your renewal 60 days before your current authorization expires. Submit updated clinical documentation showing treatment response, failed alternatives,

Do You Qualify for Cystadane Coverage by Cigna in North Carolina? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Cystadane Coverage Yes, you likely qualify for Cystadane (betaine anhydrous) coverage by Cigna in North Carolina if you have confirmed homocystinuria with elevated plasma homocysteine (>50-100 µmol/L) and genetic or biochemical confirmation. Most approvals require prior authorization through Express Scripts/Accredo with

Complete Guide to Getting Keppra (Levetiracetam) Covered by UnitedHealthcare in North Carolina: Forms, Appeals, and Medical Necessity Requirements

Answer Box: Fast Track to Keppra Coverage Generic levetiracetam typically requires no prior authorization on UnitedHealthcare plans, while brand Keppra needs PA with documented 4-week generic trial failure. Submit via UHC Provider Portal with seizure logs, prior medication failures, and medical necessity letter. Standard review takes 3-5 business days; expedited

How to Get Mycapssa (Octreotide Oral) Covered by Aetna CVS Health in North Carolina: Appeals, Prior Authorization, and State Protections

Answer Box: Getting Mycapssa Covered by Aetna CVS Health in North Carolina Fastest path to approval: Submit prior authorization through CVS Specialty (1-800-237-2767) with documented acromegaly diagnosis, prior response to injectable octreotide/lanreotide, and medical necessity letter. If denied, file internal appeal within 180 days citing North Carolina step therapy

How to Get Adynovate (bdanocog alfa pegol) Approved by Aetna CVS Health in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Adynovate Approved by Aetna CVS Health in North Carolina Aetna CVS Health requires prior authorization for Adynovate (bdanocog alfa pegol) in North Carolina. Most requests are approved when you submit complete documentation showing hemophilia A diagnosis, factor VIII levels, bleeding history, and medical necessity for extended half-life

How Long Does It Take to Get Symdeko (Tezacaftor/Ivacaftor) Approved by Aetna CVS Health in North Carolina? Complete Timeline Guide

Answer Box: Getting Symdeko Approved by Aetna CVS Health in North Carolina Typical timeline: 1-14 days for standard prior authorization, 24-72 hours for urgent requests. Aetna CVS Health requires prior authorization for Symdeko (tezacaftor/ivacaftor) with documented CF diagnosis, eligible CFTR genotype, and age ≥6 years. Fastest path: Submit complete

How to Get Rapivab (Peramivir) Covered by Blue Cross Blue Shield in North Carolina: Appeals, Forms, and State Protections

Answer Box: Getting Rapivab Covered by Blue Cross Blue Shield in North Carolina Blue Cross Blue Shield of North Carolina requires prior authorization for Rapivab (peramivir), listed under "Prior Review" in their 2024-2025 formularies. To get approval: (1) Submit a PA request via the BCBS NC provider portal