Topic

North Carolina

A collection of 504 issues

How Long Does It Take to Get Crysvita (burosumab) Approved by Blue Cross Blue Shield of North Carolina? Complete Timeline & Appeals Guide

Answer Box: Fastest Path to Crysvita Coverage in North Carolina Blue Cross Blue Shield of North Carolina typically takes 15 business days for standard Crysvita prior authorization, 72 hours for expedited review. Submit complete PA via Blue e portal with genetic confirmation (PHEX mutation), baseline labs (low serum phosphorus), and

The Requirements Checklist to Get Idelvion (Albutrepenonacog Alfa) Covered by UnitedHealthcare in North Carolina: Prior Authorization, Appeals, and Coding Guide

Answer Box: Getting Idelvion Covered by UnitedHealthcare in North Carolina Idelvion (albutrepenonacog alfa) requires prior authorization under UnitedHealthcare through OptumRx in North Carolina. Your fastest path to approval: (1) Confirm your hemophilia B diagnosis with recent factor IX activity levels and inhibitor testing, (2) Have your hematologist submit a complete

Renewing Waylivra (Volanesorsen) Approval with Humana in North Carolina: Essential Preparation Guide

Quick Answer: Waylivra (volanesorsen) requires annual prior authorization renewal with Humana Medicare Advantage plans. Start the renewal process 30 days before your current approval expires by having your prescriber submit updated clinical documentation showing ongoing medical necessity, treatment response, and safety monitoring. If denied, you have 65 days to appeal

Renewing Duopa (Carbidopa/Levodopa Enteral) Coverage with Cigna in North Carolina: Timeline, Documentation & Appeals

Quick Answer: Renewing Your Duopa Coverage in North Carolina Cigna approves Duopa renewals for 1-year periods when you still meet the original criteria and show continued benefit. Start your renewal 30-45 days before expiration. You'll need: updated neurology notes documenting ongoing advanced Parkinson's with OFF episodes,

How to Get Epidiolex (Cannabidiol) Covered by Blue Cross Blue Shield in North Carolina: Forms, Appeals, and Formulary Alternatives

Answer Box: Getting Epidiolex Covered by Blue Cross Blue Shield in North Carolina Blue Cross Blue Shield of North Carolina covers Epidiolex (cannabidiol) as a specialty drug with prior authorization for FDA-approved seizure conditions (Lennox-Gastaut syndrome, Dravet syndrome, tuberous sclerosis complex). First step: Have your neurologist submit a PA request

How to Get Pomalyst (Pomalidomide) Covered by Cigna in North Carolina: Complete 2025 Guide with Forms and Appeal Scripts

Answer Box: Getting Pomalyst Covered by Cigna in North Carolina Cigna covers Pomalyst (pomalidomide) for multiple myeloma with prior authorization after at least one prior regimen including lenalidomide and/or a proteasome inhibitor. Medicare Advantage plans list it as Tier 4 specialty; commercial plans require PA and often step therapy.

How to Get Oxervate (Cenegermin) Covered by Cigna in North Carolina: Prior Authorization, Appeals, and Approval Guide

Answer Box: Quick Eligibility Check To get Oxervate (cenegermin) covered by Cigna in North Carolina, you need: (1) Stage 2 or 3 neurotrophic keratitis diagnosed by an ophthalmologist, (2) documented failure of preservative-free artificial tears for 4-6 weeks, and (3) prior authorization through Accredo specialty pharmacy. First step today: Have

The Requirements Checklist to Get Revlimid (lenalidomide) Covered by UnitedHealthcare in North Carolina

Answer Box: Getting Revlimid Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Revlimid (lenalidomide) in North Carolina, with specific criteria for multiple myeloma, MDS, and mantle cell lymphoma. The fastest path: verify REMS enrollment, submit PA via UHC provider portal with diagnosis-specific documentation, and use North Carolina&

Lowering Out-of-Pocket Costs for Ruconest with UnitedHealthcare in North Carolina: Copay Cards, Appeals & Financial Assistance

Answer Box: Getting Ruconest Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Ruconest (C1 esterase inhibitor [recombinant]) in North Carolina, with 12-month approvals for confirmed hereditary angioedema (HAE) patients prescribed by allergists/immunologists. The fastest path: 1) Have your HAE specialist submit PA via UHC Provider Portal

Lowering Out-of-Pocket Costs for Ilaris (Canakinumab) with UnitedHealthcare in North Carolina: Coverage, Appeals & Financial Assistance

Answer Box: Getting Ilaris Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Ilaris (canakinumab) under the medical benefit, with step therapy requirements for most indications. Start by having your specialist submit a PA request via the UHC provider portal with complete clinical documentation. If denied, appeal within