Topic

North Carolina

A collection of 504 issues

Get Brineura (Cerliponase Alfa) Covered by Aetna (CVS Health) in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Brineura Covered by Aetna in North Carolina Fastest path to approval: Have a CLN2-specialized neurologist submit prior authorization through Aetna's provider portal with documented motor function scores ≥1 on the CLN2 Clinical Rating Scale, confirmed TPP1 deficiency, and an approved intraventricular administration site. Authorization typically

How to Get Carbaglu (Carglumic Acid) Covered by Humana in North Carolina: Prior Authorization Guide with Appeal Process

Answer Box: Getting Carbaglu Approved by Humana in North Carolina Humana requires prior authorization (PA) for Carbaglu (carglumic acid) in North Carolina due to its specialty status and high cost. Most approvals take 72 hours for standard review or 24 hours for expedited cases when medical urgency is documented. The

How to Get Ferriprox (deferiprone) Covered by Humana in North Carolina: Appeals Guide with Forms and Timelines

Answer Box: Getting Ferriprox (deferiprone) Covered by Humana in North Carolina Ferriprox (deferiprone) is typically covered by Humana Medicare Advantage plans in North Carolina with prior authorization and Tier 5 specialty cost-sharing. Most denials stem from missing step therapy documentation or inadequate medical necessity evidence. Fastest path to approval: 1)

The Requirements Checklist to Get Ferriprox (deferiprone) Covered by Blue Cross Blue Shield in North Carolina

Answer Box: Getting Ferriprox Covered by Blue Cross Blue Shield in North Carolina Who qualifies: Patients with transfusional iron overload from thalassemia, sickle cell disease, or other anemias who need deferiprone (Ferriprox) therapy. Fastest path to approval: 1) Verify your Blue Cross NC plan type and formulary status, 2) Submit

Do You Qualify for Tavalisse Coverage by Aetna CVS Health in North Carolina? Decision Tree & Next Steps

Answer Box: Quick Path to Tavalisse Coverage Yes, you likely qualify if you have chronic ITP (platelets <100,000 for ≥12 months), failed corticosteroids/IVIG, have platelets <50,000 or bleeding symptoms, and see a hematologist. Fastest approval: Submit Aetna's PA through Availity portal with complete

Get Takhzyro (Lanadelumab-flyo) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization Guide with Forms and Appeal Scripts

Answer Box: Getting Takhzyro Approved by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Takhzyro (lanadelumab-flyo) with specific criteria: confirmed HAE diagnosis with C1-INH deficiency, baseline attack rate ≥1 per 4 weeks, and prescribing by an allergist/immunologist. Submit through the UnitedHealthcare Provider Portal with lab results, attack documentation,

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

Answer Box: Getting Sylvant (siltuximab) Covered by Aetna (CVS Health) in North Carolina Sylvant requires prior authorization from Aetna (CVS Health) for idiopathic multicentric Castleman disease (iMCD). The fastest path: ensure your oncologist submits complete documentation showing HIV-negative/HHV-8-negative status, multicentric pathology, and active disease. If denied, North Carolina'

How to Get Natpara (Parathyroid Hormone) Approved by UnitedHealthcare in North Carolina: Complete Timeline & Appeals Guide

Answer Box: Getting Natpara Approved by UnitedHealthcare in North Carolina Important Update: Takeda permanently discontinued Natpara manufacturing in December 2024, with the Special Use Program ending December 31, 2025. New patient approvals are extremely unlikely due to lack of commercial supply. For existing patients: UnitedHealthcare typically requires 1-15 business days

How to Get Tavalisse (fostamatinib) Covered by Humana in North Carolina: Complete Appeals Guide with Forms and Scripts

Answer Box: Getting Tavalisse Covered by Humana in North Carolina Tavalisse (fostamatinib) requires prior authorization and formulary exception from Humana in North Carolina. Most approvals need documented failure of steroids, IVIG, and at least one TPO receptor agonist, plus hematologist prescription. First step today: Have your hematologist gather treatment history

Myths vs. Facts: Getting Cometriq (Cabozantinib) Covered by Blue Cross Blue Shield in North Carolina - Complete Prior Authorization Guide

Answer Box: Getting Cometriq Covered by Blue Cross Blue Shield in North Carolina Eligibility: Blue Cross Blue Shield of North Carolina covers Cometriq (cabozantinib capsules) as a specialty drug requiring prior authorization for FDA-approved medullary thyroid carcinoma. Fastest path: Your oncologist submits a PA through the Prime Therapeutics portal with