Topic

North Carolina

A collection of 444 issues

Renewing Opsumit (Macitentan) Approval with UnitedHealthcare in North Carolina: 2025 Requirements & Timeline

Answer Box: Opsumit (macitentan) renewal with UnitedHealthcare in North Carolina requires submitting updated clinical documentation 30-60 days before your current authorization expires. Key 2025 changes: OptumRx is eliminating many chronic disease reauthorizations, but Opsumit's status must be verified through your provider portal. If still required, submit WHO functional

How to Get Isturisa (Osilodrostat) Covered by Cigna in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Isturisa (Osilodrostat) Covered by Cigna in North Carolina Eligibility: Cigna covers Isturisa for adult Cushing's disease when surgery isn't an option or wasn't curative, prescribed by an endocrinologist with documented abnormal cortisol tests. Fastest path: Submit prior authorization through Cigna'

How to Get Galafold (migalastat) Covered by UnitedHealthcare in North Carolina: Requirements, Appeals, and Smart NC External Review

Answer Box: Getting Galafold Covered by UnitedHealthcare in North Carolina To get Galafold (migalastat) covered by UnitedHealthcare in North Carolina, you need: (1) confirmed Fabry disease diagnosis with amenable GLA variant documented by genetic testing, (2) specialist evaluation (nephrology, genetics, or metabolics), and (3) prior authorization submission through OptumRx with

Get Orladeyo (Berotralstat) Covered by Humana in North Carolina: Complete Guide with Forms and Appeal Steps

Answer Box: Getting Orladeyo (Berotralstat) Covered by Humana in North Carolina Orladeyo (berotralstat) requires prior authorization from Humana and must be prescribed by an HAE specialist. The fastest path to approval: 1. Get diagnosed by an in-network allergist/immunologist with confirmed C1-INH testing showing hereditary angioedema 2. Have your specialist

How Long Does It Take to Get Bylvay (odevixibat) Approved by Aetna CVS Health in North Carolina? Complete Timeline Guide

Answer Box: Fastest Path to Bylvay Approval Aetna CVS Health typically processes Bylvay (odevixibat) prior authorization requests within 24 hours for complete submissions. For PFIC (≥3 months) or Alagille syndrome (≥12 months) patients in North Carolina: 1. Submit complete PA request via Availity provider portal with specialist diagnosis and prior

How to Get Breyanzi Covered by Humana in North Carolina: Appeals Guide & Templates

Answer Box: Getting Breyanzi Covered by Humana in North Carolina Fastest path to approval: Submit prior authorization to Humana's Transplant Network (fax: 502-508-9300) with complete clinical documentation showing you meet FDA-approved indications for large B-cell lymphoma or CLL after ≥2 prior therapies. If denied, you have 65 days

Coding That Helps Get Rystiggo (Rozanolixizumab-noli) Approved by UnitedHealthcare in North Carolina: ICD-10, J-Code, and Prior Authorization Guide

Answer Box: Fast Track to Rystiggo Coverage Getting Rystiggo (rozanolixizumab-noli) covered by UnitedHealthcare in North Carolina requires proper coding and prior authorization. Use ICD-10 codes G70.00 (no exacerbation) or G70.01 (with exacerbation), bill with J-code J9333, and document AChR or MuSK antibody positivity. UnitedHealthcare requires prior authorization through

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Blue Cross Blue Shield of North Carolina: Complete Forms, Appeals & Timelines Guide

Answer Box: Getting Enhertu Covered in North Carolina Blue Cross Blue Shield of North Carolina requires prior authorization for Enhertu (fam-trastuzumab deruxtecan-nxki) as of July 2024. Your fastest path to approval: (1) Ensure your provider submits complete HER2 testing documentation and clinical notes via the Blue Cross NC provider portal,

If Zolgensma Isn't Approved by Blue Cross Blue Shield in North Carolina: Spinraza, Evrysdi & Exception Strategies

Answer Box: Your Next Steps When Zolgensma Is Denied If Blue Cross Blue Shield North Carolina denies Zolgensma (onasemnogene abeparvovec) for spinal muscular atrophy, you have proven alternatives: Spinraza (nusinersen) and Evrysdi (risdiplam) are both FDA-approved, disease-modifying SMA treatments typically covered on BCBS formularies. First step: Request your neurologist submit

How to Get Cimzia (Certolizumab Pegol) Covered by Blue Cross Blue Shield of North Carolina: Complete Guide to Prior Authorization, Appeals, and State Protections

Answer Box: Getting Cimzia Covered in North Carolina Cimzia (certolizumab pegol) requires prior authorization from Blue Cross Blue Shield of North Carolina and is subject to step therapy requirements. The fastest path to approval: 1) Submit PA with documented failure of preferred TNF inhibitors, 2) Include TB/HBV screening and