Topic

North Carolina

A collection of 504 issues

How to Get Joenja (leniolisib) Covered by Blue Cross Blue Shield of North Carolina: Complete Appeals Guide

Answer Box: Quick Path to Coverage To get Joenja (leniolisib) covered by Blue Cross Blue Shield of North Carolina (BCBSNC): 1) Confirm APDS diagnosis with genetic testing via navigateAPDS.com (free), 2) Submit prior authorization through BCBSNC's specialty pharmacy network with medical necessity documentation, 3) If denied, file

Getting Kalydeco (Ivacaftor) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Fastest Path to Kalydeco Approval in North Carolina Aetna CVS Health requires prior authorization for Kalydeco (ivacaftor) with CFTR genetic testing confirming FDA-approved mutations (like G551D), CF specialist prescription, and baseline labs. Submit via Availity portal with genetic test results, specialist notes, and pulmonary function tests. If denied,

How to Get Naglazyme (Galsulfase) Covered by Cigna in North Carolina: Prior Authorization Guide and Appeals Process

Answer Box: Getting Naglazyme (Galsulfase) Covered by Cigna in North Carolina Cigna requires prior authorization for Naglazyme (galsulfase) with enzyme/genetic confirmation of MPS VI diagnosis. Submit through Express Scripts/Accredo with specialist documentation including baseline functional assessments (6-minute walk test, pulmonary function). If denied, North Carolina's Smart

Renewing Mycapssa (Octreotide Oral) Approval with UnitedHealthcare in North Carolina: Complete 2025 Guide

Answer Box: Mycapssa Renewal Essentials UnitedHealthcare requires annual reauthorization for Mycapssa (oral octreotide) in North Carolina, approving 12-month renewals based on documented clinical response—typically normalized IGF-1 levels and symptom improvement. Submit renewal requests 30-60 days before expiration via the OptumRx Provider Portal or fax (866-889-8054) with recent labs, treatment

How to Get Berinert Approved by Humana in North Carolina: PA Forms, Appeals, and Alternative Coverage Paths

Answer Box: Getting Berinert Covered by Humana in North Carolina Humana requires prior authorization (PA) for Berinert (C1-esterase inhibitor, IV) for hereditary angioedema (HAE) treatment. Submit PA requests through Humana's provider portal with HAE diagnosis confirmation, attack history, and specialist prescription. If denied, you have 65 days to

Work With Your Doctor to Get Jaypirca (Pirtobrutinib) Approved by Cigna in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Jaypirca (Pirtobrutinib) Covered by Cigna in North Carolina Cigna requires prior authorization for Jaypirca (pirtobrutinib), a specialty BTK inhibitor for relapsed mantle cell lymphoma or CLL/SLL after prior BTK inhibitor failure. Your doctor must submit clinical documentation proving prior therapy failures and medical necessity through Accredo

The Requirements Checklist to Get Lumizyme (Alglucosidase Alfa) Covered by UnitedHealthcare in North Carolina: Forms, Appeals, and Timeline

Answer Box: Getting Lumizyme Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Lumizyme (alglucosidase alfa) with confirmed Pompe disease diagnosis (ICD-10: E74.02), GAA enzyme deficiency testing, and specialist prescriber. Submit via the UnitedHealthcare Provider Portal with complete clinical documentation. If denied, North Carolina residents can appeal

How to Get Symdeko/Symkevi Covered by Blue Cross Blue Shield North Carolina: Complete Prior Authorization and Appeals Guide

Quick Answer: Blue Cross Blue Shield of North Carolina covers Symdeko/Symkevi (tezacaftor/ivacaftor) as a Tier 5 specialty medication requiring prior authorization and genetic testing documentation. Submit PA through your CF specialist with CFTR genotype results showing F508del or responsive mutations. If denied, appeal internally within 180 days, then

How to Get Rebif (Interferon Beta-1a) Covered by Cigna in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Rebif Covered by Cigna in North Carolina Rebif (interferon beta-1a) requires prior authorization through Cigna's specialty pharmacy partner Accredo. Your neurologist must submit clinical documentation showing confirmed relapsing MS, recent MRI activity, and safety labs (CBC, liver function tests). If denied, you have 180 days

Work With Your Doctor to Get Voxzogo (vosoritide) Covered by UnitedHealthcare in North Carolina: Complete PA Guide and Appeal Strategy

Answer Box: Getting Voxzogo Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Voxzogo (vosoritide) in children under 18 with achondroplasia and open growth plates. Work with your pediatric endocrinologist or geneticist to submit genetic testing, bone age X-rays, baseline growth data, and a medical necessity letter through