Topic

North Carolina

A collection of 431 issues

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

How to Get Isturisa (Osilodrostat) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Isturisa Covered by Aetna CVS Health in North Carolina Fastest path to approval: Submit Aetna's specialty medication prior authorization form through the Availity provider portal with complete documentation: confirmed Cushing's disease diagnosis, failed pituitary surgery or contraindication, and prescription from an endocrinologist. Standard
6 min read

How to Get Retevmo (Selpercatinib) Covered by Blue Cross Blue Shield in North Carolina: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Retevmo Covered by BCBS North Carolina Blue Cross Blue Shield of North Carolina requires prior authorization for Retevmo (selpercatinib) for RET fusion-positive NSCLC and thyroid cancers. You'll need FDA-approved RET testing results, pathology reports, and clinical documentation. If denied, file internal appeals within 180 days,
5 min read

How to Get Idelvion (albutrepenonacog alfa) Covered by Humana in North Carolina: Prior Authorization, Appeals, and Medical Necessity Guide

Answer Box: Getting Idelvion Covered by Humana in North Carolina Idelvion requires prior authorization from Humana Medicare Advantage plans in North Carolina. You'll need confirmed hemophilia B diagnosis (Factor IX <40%), documented step therapy attempts with standard products, and clinical justification for extended half-life therapy. Start today:
5 min read

How to Get Elaprase (Idursulfase) Covered by Aetna (CVS Health) in North Carolina: Complete Appeals Guide with Forms and Timelines

Answer Box: Fast Track to Elaprase Coverage To get Elaprase (idursulfase) covered by Aetna (CVS Health) in North Carolina: Submit the Aetna Elaprase Precertification Form with enzymatic/genetic test results confirming Hunter syndrome diagnosis, current weight documentation, and specialist attestation. If denied, appeal internally within 180 days, then file for
6 min read

How to Get Pemazyre (pemigatinib) Covered by Humana in North Carolina: Complete Guide to Prior Authorization, Appeals, and Approval

Answer Box: Fastest Path to Pemazyre Coverage Pemazyre (pemigatinib) requires prior authorization from Humana in North Carolina. You'll need documented FGFR2 fusion/rearrangement testing, baseline ophthalmologic monitoring plan, and proof of prior systemic therapy failure. Submit complete documentation through Humana's provider portal for 72-hour standard review.
6 min read

Renewing Your Lamzede (velmanase alfa-tycv) Approval with Blue Cross Blue Shield in North Carolina: Complete 2025 Guide

Answer Box: Lamzede Renewal with BCBS North Carolina Blue Cross Blue Shield of North Carolina requires annual prior authorization renewal for Lamzede (velmanase alfa-tycv). Start your renewal process 60-90 days before expiration to avoid treatment gaps. You'll need updated clinical documentation showing therapeutic response, specialist oversight, and continued
5 min read

How to Get Fabrazyme (agalsidase beta) Covered by Blue Cross Blue Shield of North Carolina: Complete PA Guide with Forms and Appeal Scripts

Answer Box: Getting Fabrazyme Covered by BCBS North Carolina Fabrazyme (agalsidase beta) requires prior authorization from Blue Cross Blue Shield of North Carolina for both commercial and Medicare plans. Success depends on three key elements: confirmed Fabry disease diagnosis with genetic/enzyme testing, specialist prescriber documentation, and complete clinical rationale.
6 min read