Topic

North Carolina

A collection of 433 issues

Poteligeo (mogamulizumab-kpkc) Approval with Aetna (CVS Health) in North Carolina: Complete Guide to Prior Authorization, Appeals, and Patient Support

Answer Box: Getting Poteligeo Covered by Aetna (CVS Health) in North Carolina Poteligeo (mogamulizumab-kpkc) requires prior authorization from Aetna (CVS Health) for mycosis fungoides or Sézary syndrome. Your dermatologist or oncologist must document failed prior systemic therapy (not just topical treatments) and submit clinical evidence through Aetna's provider

Getting Garadacimab (Andembry) Covered by Aetna CVS Health in North Carolina: A Complete Prior Authorization Guide

Answer Box: Getting Garadacimab (Andembry) Covered by Aetna CVS Health in North Carolina Eligibility: You need confirmed HAE diagnosis (low C4, abnormal C1-INH levels) and documented failure/intolerance to at least one prior prophylactic therapy. Fastest path: Have your specialist submit prior authorization through CVS Caremark with complete lab results,

How to Get Strimvelis Gene Therapy Covered by Cigna in North Carolina: Forms, Appeals, and Smart NC External Review

Answer Box: Getting Strimvelis Covered by Cigna in North Carolina Strimvelis (autologous CD34+ ADA-SCID gene therapy) requires prior authorization from Cigna and is only available at SR-TIGET in Milan, Italy. For North Carolina residents, the fastest path to approval involves: (1) Submit PA request via CoverMyMeds with confirmed ADA-SCID diagnosis

Myths vs. Facts: Getting Evkeeza (evinacumab-dgnb) Covered by UnitedHealthcare in North Carolina

Answer Box Getting Evkeeza (evinacumab-dgnb) covered by UnitedHealthcare in North Carolina requires: confirmed homozygous familial hypercholesterolemia diagnosis, documented failure of statin + ezetimibe + PCSK9 inhibitor, and prior authorization through the UnitedHealthcare Provider Portal. If denied, you have 180 days to appeal internally, then can request external review through North Carolina'

How to Get Nourianz (Istradefylline) Covered by Cigna in North Carolina: Appeals Guide with Forms and Timelines

Answer Box: Getting Nourianz Covered by Cigna in North Carolina Cigna requires prior authorization for Nourianz (istradefylline) with strict step therapy requirements. You must have tried and failed amantadine, a MAO-B inhibitor (like rasagiline), and a COMT inhibitor (like entacapone) before approval. If denied, Cigna members have strong appeal rights

Myths vs. Facts: Getting Xembify (Immune Globulin, SC) Covered by Aetna (CVS Health) in North Carolina

Answer Box: Getting Xembify Covered by Aetna in North Carolina Eligibility: Primary immunodeficiency diagnosis with documented low IgG levels and infection history. Fastest path: Submit prior authorization through CVS Specialty with complete diagnostic labs, prior IVIG/SCIG failure documentation, and specialist letter. First step today: Call Aetna at (866) 752-7021

How to Get Cometriq (Cabozantinib) Covered by Humana in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Cometriq Covered by Humana in North Carolina Cometriq (cabozantinib) requires prior authorization from Humana and must be dispensed through CenterWell Specialty Pharmacy or another in-network specialty pharmacy. Your oncologist needs to submit documentation proving progressive, metastatic medullary thyroid carcinoma with pathology reports, recent imaging, and confirmation that

How to Get Imbruvica (ibrutinib) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Imbruvica Covered by UnitedHealthcare in North Carolina Most UnitedHealthcare members in North Carolina can get Imbruvica (ibrutinib) covered through OptumRx's prior authorization process. The key steps: verify your diagnosis meets medical necessity criteria (CLL, SLL, or Waldenström macroglobulinemia), gather comprehensive clinical documentation, and submit the

Getting Orkambi (lumacaftor/ivacaftor) Covered by Cigna in North Carolina: Complete Guide to Prior Authorization, Appeals, and Templates

Quick Answer: Getting Orkambi Covered by Cigna in North Carolina Cigna requires prior authorization for Orkambi (lumacaftor/ivacaftor) with proof of homozygous F508del mutation and CF specialist prescription. If denied, you have 180 days for internal appeals, then can request external review through North Carolina's Smart NC program.

How to Get Amondys 45 (Casimersen) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Amondys 45 Covered by Aetna CVS Health in North Carolina Aetna CVS Health requires prior authorization for Amondys 45 (casimersen) with strict documentation: genetic testing confirming exon 45-amenable DMD mutation, age under 14, specialist prescription, and detailed monitoring plan. If denied, North Carolina residents can appeal internally