Topic

North Carolina

A collection of 504 issues

Myths vs. Facts: Getting Firazyr (icatibant injection) Covered by Cigna in North Carolina

Answer Box: Getting Firazyr Covered by Cigna in North Carolina Cigna covers Firazyr (icatibant) for confirmed HAE Type I/II with prior authorization requiring specialist prescription, C1-INH/C4 lab documentation, and self-administration training proof. If denied, you have 180 days for internal appeals, then can use North Carolina's

How to Get Palynziq (pegvaliase-pqpz) Covered by UnitedHealthcare in North Carolina: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Palynziq Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Palynziq (pegvaliase-pqpz) for adults with PKU and blood phenylalanine >600 µmol/L. The fastest path: submit PA through the UHC provider portal with PKU diagnosis (ICD-10 E70.0), recent Phe labs >600 µmol/

How to Renew Fabrazyme (Agalsidase Beta) Coverage with Humana in North Carolina: 2025 Requirements & Timeline

Answer Box: Renewing Fabrazyme Coverage with Humana in North Carolina For Humana Medicare Advantage members: Start renewal 30 days before your current authorization expires. Submit via Humana's electronic portal with updated clinical documentation showing ongoing benefit. For commercial Humana plans: You may also use North Carolina's

How to Get Zolgensma Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Zolgensma Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization through OptumRx for Zolgensma (onasemnogene abeparvovec-xioi) with strict clinical criteria: genetic confirmation of bi-allelic SMN1 mutations, age under 2 years, anti-AAV9 antibody titer ≤1:50, and documented steroid protocol. If denied, North Carolina residents can appeal

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

Answer Box: Getting Givlaari (givosiran) covered by Aetna (CVS Health) in North Carolina requires prior authorization with specific documentation: elevated ALA/PBG levels during attacks, attack history requiring hospitalization or hemin, and specialist prescriber. Submit via CVS Caremark Specialty or Availity portal. If denied, North Carolina's Smart NC

Renewing Sumavel DosePro (Sumatriptan Injection, Needle-Free) Approval with Blue Cross Blue Shield in North Carolina: Annual Requirements & Timeline

Answer Box: Renewing Your Sumavel DosePro Authorization Blue Cross Blue Shield of North Carolina typically requires annual prior authorization renewal for Sumavel DosePro (sumatriptan injection, needle-free). Start the renewal process 60-90 days before your current approval expires to avoid coverage gaps. You'll need updated clinical documentation showing continued

How to Get Kymriah (tisagenlecleucel) Covered by Blue Cross Blue Shield of North Carolina: Complete Guide with Forms, Deadlines & Appeal Scripts

Answer Box: Getting Kymriah Covered by Blue Cross NC Blue Cross Blue Shield of North Carolina requires prior authorization for Kymriah (tisagenlecleucel) CAR-T therapy. Your fastest path: Submit via Availity portal with CD19-positive pathology, prior therapy documentation, and treatment at a certified CAR-T center. Appeals success rate is high when

How to Get Ocrevus Covered by UnitedHealthcare in North Carolina: PA Forms, Appeals, and Approval Timeline

Answer Box: Getting Ocrevus Covered by UnitedHealthcare in North Carolina UnitedHealthcare covers Ocrevus (ocrelizumab) in North Carolina when prior authorization criteria are met: confirmed MS diagnosis (relapsing forms or primary progressive), documented treatment history, and clinical necessity. No universal step therapy requirement exists in UHC's national policy, but

Myths vs. Facts: Getting Eloctate (Coagulation Factor VIII) Covered by Humana in North Carolina - Appeals Guide

Quick Answer: Getting Eloctate Covered by Humana in North Carolina Fastest path to approval: Have your hematologist submit prior authorization through Humana's provider portal with comprehensive bleeding logs, prior factor VIII failures, and medical necessity documentation. If denied, file internal appeal within 65 days, then request Smart NC

Getting Strimvelis Gene Therapy Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Strimvelis Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Strimvelis (autologous CD34+ ADA-SCID gene therapy) as a non-formulary, international specialty treatment. Start by confirming your ADA-SCID diagnosis with genetic testing, documenting failed or contraindicated alternatives, and submitting through the UHC Provider Portal. If denied,