Topic

North Carolina

A collection of 430 issues

Getting Signifor LAR (Pasireotide) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Approval UnitedHealthcare requires prior authorization for Signifor LAR (pasireotide) with specific criteria: confirmed endogenous Cushing's disease and documentation that pituitary surgery was non-curative or not viable. No step therapy required. Your board-certified endocrinologist must submit through OptumRx with biochemical proof (abnormal UFC or
5 min read

How to Get Upstaza (Eladocagene Exuparvovec) Approved by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Upstaza Covered by UnitedHealthcare in North Carolina To get Upstaza (eladocagene exuparvovec) approved by UnitedHealthcare in North Carolina, you need: (1) genetic confirmation of biallelic DDC mutations from a CLIA-certified lab, (2) biochemical evidence (AADC enzyme activity <50% normal or abnormal CSF profile), and (3) treatment
6 min read

Myths vs. Facts: Getting Koselugo (Selumetinib) Covered by Aetna CVS Health in North Carolina - Complete Appeals Guide

Answer Box: Getting Koselugo Covered by Aetna CVS Health in North Carolina Eligibility: Pediatric patients ≥2 years with confirmed NF1 and symptomatic, inoperable plexiform neurofibromas. Fastest approval path: Submit complete prior authorization with baseline LVEF assessment, ophthalmologic evaluation, and MRI-confirmed diagnosis through CVS Specialty. First step today: Contact your pediatric
5 min read

How to Get Cosentyx (secukinumab) Approved by Aetna CVS Health in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Cosentyx Approved by Aetna CVS Health in North Carolina Eligibility: Patients with moderate-to-severe plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, or hidradenitis suppurativa who meet step therapy requirements. Fastest Path: Complete Aetna's Cosentyx precertification form, document prior therapy failures, submit TB screening results, and submit via
7 min read

How to Get StrataGraft Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting StrataGraft Covered by UnitedHealthcare in North Carolina StrataGraft requires prior authorization from UnitedHealthcare as a facility-billed medical benefit (not pharmacy) for deep partial-thickness thermal burns. Start by having your burn specialist submit complete documentation through the UnitedHealthcare Provider Portal. If denied, you have 180 days for internal
5 min read

How to Get Qalsody (Tofersen) Covered by UnitedHealthcare in North Carolina: Prior Authorization, Appeals, and State Review Guide

Answer Box: Getting Qalsody Covered by UnitedHealthcare in North Carolina Eligibility: UnitedHealthcare covers Qalsody (tofersen) for ALS patients with confirmed SOD1 mutations, but requires prior authorization through OptumRx. The medication sits on Specialty Tier with 30-50% coinsurance. Fastest Path: 1) Gather SOD1 genetic test results and baseline ALSFRS-R scores, 2)
6 min read

How to Get Cimzia (Certolizumab Pegol) Covered by Aetna (CVS Health) in North Carolina: Complete Appeals Guide and Timeline

Answer Box: Getting Cimzia Covered by Aetna in North Carolina Eligibility: Cimzia requires prior authorization from Aetna (CVS Health) for all patients. You must have documented failure or intolerance to preferred alternatives and complete TB/hepatitis B screening. Fastest path: Submit complete prior authorization with medical necessity letter, screening results,
6 min read

Getting Tagrisso (Osimertinib) Covered by Cigna in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Approval Cigna requires prior authorization for Tagrisso (osimertinib) with documented EGFR mutation testing and oncologist prescribing. Fastest approval path: Submit PA through Express Scripts/Accredo with EGFR mutation results, pathology report, and medical necessity letter. If denied, file internal appeal within 180 days, then request
6 min read

UnitedHealthcare's Coverage Criteria for Darzalex (Daratumumab) in North Carolina: Complete Medical Necessity Guide

Answer Box: Getting Darzalex Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Darzalex (daratumumab) with specific medical necessity criteria: confirmed multiple myeloma diagnosis, appropriate treatment line documentation, and FDA-approved or NCCN guideline-supported regimens. Submit PA requests through the UnitedHealthcare Provider Portal with complete clinical documentation. If denied,
6 min read