Topic

North Carolina

A collection of 430 issues

How to Get Vyndaqel/Vyndamax (Tafamidis) Covered by Cigna in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Vyndaqel/Vyndamax Covered by Cigna in North Carolina Fastest Path to Approval: Cigna requires prior authorization for tafamidis with confirmed ATTR-CM diagnosis via PYP scan or biopsy, cardiology oversight, and NYHA Class I-III status. First step today: Gather your diagnostic reports and contact your cardiologist to initiate

The Requirements Checklist to Get Juxtapid (lomitapide) Covered by Blue Cross Blue Shield in North Carolina

Answer Box: Getting Juxtapid Covered in North Carolina Juxtapid (lomitapide) requires prior authorization from Blue Cross Blue Shield in North Carolina. Success depends on documenting homozygous familial hypercholesterolemia (HoFH) diagnosis, step therapy failures, and liver monitoring plans per FDA REMS requirements. First step: contact your prescriber to initiate prior authorization

How to Get Cimzia (Certolizumab Pegol) Covered by Humana in North Carolina: Prior Authorization, Appeals, and Step Therapy Guide

Quick Answer: Getting Cimzia Covered by Humana in North Carolina Step 1: Your doctor submits a prior authorization request to Humana, documenting your diagnosis and failed treatments with preferred anti-TNF biologics (step therapy requirement). Step 2: If denied, file an internal appeal within 65 days. Step 3: If still denied,

How to Get Garadacimab (Andembry) Covered by Humana in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Garadacimab Covered by Humana in North Carolina Garadacimab (Andembry) requires prior authorization from Humana and faces step therapy requirements. You must document failed trials with preferred HAE prophylaxis medications first. Standard PA decisions take 30 days (72 hours expedited). If denied, Humana Medicare Advantage uses federal appeals;

How to Get Hemgenix (Etranacogene Dezaparvovec) Covered by Humana in North Carolina: Prior Authorization Guide and Appeals Process

Answer Box: Getting Hemgenix Covered by Humana in North Carolina Hemgenix (etranacogene dezaparvovec) requires prior authorization from Humana for adults with moderate to severe hemophilia B. The fastest path to approval involves three key steps: (1) Have your hematologist submit a comprehensive PA request with Factor IX levels ≤2%, bleeding

How to Get Crysvita (Burosumab) Covered by Humana in North Carolina: Prior Authorization, Appeals & Step Therapy Guide

Answer Box: Getting Crysvita Covered by Humana in North Carolina Crysvita (burosumab) requires prior authorization from Humana and step therapy through oral phosphate plus vitamin D analogs first. To get coverage in North Carolina: (1) Document failed conventional therapy with your endocrinologist, (2) Submit PA request with genetic/biochemical confirmation

The Complete Requirements Checklist to Get Blenrep (Belantamab Mafodotin) Covered by UnitedHealthcare in North Carolina

Answer Box: Blenrep Coverage Status Blenrep (belantamab mafodotin) has been withdrawn from the U.S. market by GSK. UnitedHealthcare will deny coverage requests for commercial Blenrep because it's no longer commercially available. However, patients may access Blenrep through GSK's compassionate use program if already enrolled in

Getting Uptravi (Selexipag) Covered by Cigna in North Carolina: Prior Authorization Guide, Appeals Process & Alternative Options

Answer Box: Quick Path to Uptravi (Selexipag) Coverage To get Uptravi covered by Cigna in North Carolina: Your cardiologist or pulmonologist must submit prior authorization with WHO Group 1 PAH diagnosis via right heart catheterization, functional class documentation, and prior therapy trials. If denied, file internal appeal within 180 days,

Blue Cross Blue Shield North Carolina's Coverage Criteria for Breyanzi (Lisocabtagene Maraleucel): What Counts as "Medically Necessary"?

Answer Box: Getting Breyanzi Covered by BCBS North Carolina Eligibility: Breyanzi requires prior authorization from Blue Cross Blue Shield of North Carolina for specific B-cell lymphomas after multiple treatment lines. Fastest path: Have your oncologist submit a PA request through the Blue e provider portal with complete documentation of diagnosis,

How Long Does It Take to Get Sylvant (Siltuximab) Approved by UnitedHealthcare in North Carolina? Complete Timeline Guide

Answer Box: Sylvant Approval Timeline in North Carolina Standard approval: 1-5 business days for complete submissions through UnitedHealthcare's Provider Portal. Required tests: HIV-negative and HHV-8-negative lab results plus pathology confirming multicentric Castleman disease. Step therapy: May require tocilizumab or rituximab trial first. If denied: 180 days for internal