Topic

North Carolina

A collection of 54 issues

How to Get Cabometyx (Cabozantinib) Approved by UnitedHealthcare in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Cabometyx Covered by UnitedHealthcare in North Carolina Cabometyx (cabozantinib) requires prior authorization from UnitedHealthcare/OptumRx for all indications. The fastest path to approval: (1) Verify your plan covers specialty drugs through OptumRx, (2) Submit the UnitedHealthcare Cabometyx PA form with complete clinical documentation including diagnosis, prior therapies,

How to Get Natpara Covered by Blue Cross Blue Shield in North Carolina: Complete Appeals Guide with Forms and Deadlines

Answer Box: Getting Natpara Covered by Blue Cross Blue Shield in North Carolina Important Update: Natpara manufacturing ended December 2024, with the Special Use Program ceasing December 31, 2025. New patient requests are typically denied due to discontinued availability. For existing patients transitioning off Natpara, focus on documenting medical necessity

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

Answer Box: Fast Track to Evkeeza Coverage Getting Evkeeza (evinacumab-dgnb) covered by Aetna (CVS Health) in North Carolina requires prior authorization and documented failure of standard therapies. The fastest path: ensure your doctor submits comprehensive documentation of HoFH diagnosis, failed statin/ezetimibe/PCSK9 inhibitor trials, and current LDL-C levels via

How to Get Duopa Covered by Aetna CVS Health in North Carolina: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Duopa Covered by Aetna CVS Health in North Carolina Duopa (carbidopa/levodopa enteral) requires prior authorization from Aetna CVS Health and typically involves step therapy requirements. To get coverage approved in North Carolina: 1. Document failed oral therapy - Your neurologist must show you've tried

How to Get Elaprase (Idursulfase) Covered by Cigna in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Elaprase (Idursulfase) Covered by Cigna in North Carolina Eligibility: Cigna covers Elaprase for Hunter syndrome (MPS II) when you have confirmed enzymatic deficiency AND genetic testing showing IDS gene mutations. Fastest approval path: Submit prior authorization with both biochemical and molecular diagnostic proof, weight-based dosing calculations, and

How to Get Cabometyx (Cabozantinib) Covered by Cigna in North Carolina: Complete Appeals Guide

Answer Box: Getting Cabometyx Covered by Cigna in North Carolina Cigna requires prior authorization for Cabometyx (cabozantinib) with specific documentation: FDA-approved diagnosis, prior therapy failures, and prescriber attestation. Submit the Cigna PA form with complete clinical records. If denied, you have 180 days for internal appeals, then 120 days for

How to Get Strensiq (Asfotase Alfa) Covered by Cigna in North Carolina: Complete PA Guide and Appeals Strategy

Answer Box: Getting Strensiq Covered by Cigna in North Carolina Strensiq (asfotase alfa) requires prior authorization from Cigna and is typically covered only for pediatric-onset hypophosphatasia with strict documentation requirements. Your fastest path to approval: (1) Work with an HPP specialist to gather genetic testing, low ALP levels, and clinical

Coding That Helps Get Vigabatrin (Sabril) Approved by Blue Cross Blue Shield in North Carolina: ICD-10, HCPCS, and NDC Guide

Answer Box: Get Vigabatrin Covered by Blue Cross Blue Shield in North Carolina Vigabatrin requires prior authorization from Blue Cross Blue Shield NC with specific coding requirements. Use ICD-10 code G40.821 (infantile spasms) or G40.219 (refractory complex partial seizures), include NDC numbers for billing, and ensure REMS program

How to Get Vyndaqel/Vyndamax (Tafamidis) Covered by Aetna CVS Health in North Carolina: Complete Guide to Prior Authorization, Appeals, and External Review

Answer Box: Getting Tafamidis Covered by Aetna CVS Health in North Carolina Quick Path to Approval: Aetna requires prior authorization for both Vyndaqel and Vyndamax (tafamidis) with confirmed ATTR-CM diagnosis via PYP scan or biopsy, NYHA Class I-III symptoms, and specialist prescriber. First step today: Verify your 2025 formulary status—

Renewing Krystexxa (Pegloticase) Coverage with Cigna in North Carolina: Complete Guide for 2025

Answer Box: Renewing Krystexxa Coverage with Cigna in North Carolina Cigna requires prior authorization renewal for Krystexxa (pegloticase) every 12 months with strict documentation of ongoing response. Start your renewal 2-4 weeks before expiration to avoid treatment gaps. Essential requirements: serum uric acid levels below 6 mg/dL before infusions,