Topic

North Carolina

A collection of 430 issues

How to Get Filsuvez Covered by Cigna in North Carolina: Prior Authorization Forms, Appeal Scripts & External Review Guide

Answer Box: Fast-Track to Filsuvez Coverage Cigna requires prior authorization for Filsuvez (birch triterpenes topical gel) via Express Scripts/Accredo for epidermolysis bullosa patients ≥6 months with confirmed dystrophic or junctional subtypes. Submit through Cigna provider portal or CoverMyMeds with genetic testing, wound photos (10-50 cm², 21 days-9 months old)

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

Answer Box: Getting Kesimpta (ofatumumab) Covered by Aetna (CVS Health) in North Carolina Kesimpta (ofatumumab) requires prior authorization from Aetna (CVS Health) for relapsing multiple sclerosis. Submit via CVS Caremark PA portal with neurologist letter documenting relapsing MS diagnosis (ICD-10: G35), prior DMT failures, and HBV screening. Standard decisions take

How to Get Photrexa (Riboflavin) Covered by Cigna in North Carolina: Complete PA Guide and Appeals Timeline

Answer Box: Fastest Path to Approval Cigna covers FDA-approved epi-off corneal cross-linking with Photrexa riboflavin for progressive keratoconus when prior authorization criteria are met. Your ophthalmologist must document progression (≥1.0 D Kmax increase over 12-24 months) and corneal thickness ≥400 µm. Submit PA through Cigna provider portal with serial

How to Get Kymriah (tisagenlecleucel) Covered by Aetna (CVS Health) in North Carolina: Complete Guide to Prior Authorization, Appeals, and Coding

Answer Box: Fast Track to Kymriah Coverage Aetna (CVS Health) requires prior authorization for Kymriah (tisagenlecleucel) in North Carolina. Your fastest path: (1) Confirm CD19-positive pathology and treatment at an Aetna-contracted CAR-T center, (2) Submit PA with complete treatment history via 1-877-212-8811, and (3) Request expedited review (≤72 hours) if

How to Get Tracleer (Bosentan) Covered by Blue Cross Blue Shield in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Tracleer (Bosentan) Covered in North Carolina Tracleer (bosentan) requires prior authorization from Blue Cross Blue Shield of North Carolina (BCBSNC) for WHO Group 1 pulmonary arterial hypertension. Key requirements: REMS program enrollment, specialist prescriber (cardiologist/pulmonologist), baseline liver tests, and trial of generic bosentan first. If denied,

How to Get Kymriah (Tisagenlecleucel) Covered by UnitedHealthcare in North Carolina: Prior Authorization Guide with Appeal Templates

Answer Box: Quick Path to Kymriah Coverage To get Kymriah (tisagenlecleucel) covered by UnitedHealthcare in North Carolina: Your oncologist must submit prior authorization through the UHCprovider.com portal with CD19 positivity confirmation, documented prior therapy failures, and certified treatment center verification. If denied, you have 60 days to appeal internally,

How to Get Uplizna (Inebilizumab) Covered by UnitedHealthcare in North Carolina: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Getting Uplizna Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Uplizna (inebilizumab) for both AQP4-positive NMOSD and IgG4-related disease. Fastest path: Have your neurologist or rheumatologist submit PA via UHC Provider Portal with AQP4-IgG test results (for NMOSD), prior therapy failures, and medical necessity letter.

Myths vs. Facts: Getting Uptravi (Selexipag) Covered by Humana in North Carolina

Answer Box Getting Uptravi (selexipag) covered by Humana in North Carolina requires prior authorization with specific WHO Group I PAH documentation. Key requirements: right heart catheterization showing mPAP ≥25 mmHg and PCWP ≤15 mmHg, trials of two other PAH drug classes, and WHO Functional Class II-III status. If denied, file

How to Get Opsumit (macitentan) Covered by Cigna in North Carolina: Complete Appeals Guide with Forms and Timelines

Answer Box: To get Opsumit (macitentan) covered by Cigna in North Carolina, you need prior authorization with WHO Group 1 PAH confirmed by right heart catheterization, WHO functional class II-IV documentation, and specialist prescribing. If denied, exhaust Cigna's internal appeals first, then file for North Carolina's

Do You Qualify for Keppra (Levetiracetam) Coverage by Humana in North Carolina? Decision Tree & Next Steps

Answer Box: Your Path to Keppra Coverage Generic levetiracetam is typically covered by Humana without prior authorization for FDA-approved seizure disorders. Brand Keppra requires documented failure of generic. If denied, you have 65 days to appeal internally, then can request North Carolina's Smart NC external review within 120