Topic

North Carolina

A collection of 444 issues

How to Get Ruconest (C1 Esterase Inhibitor) Covered by Humana in North Carolina: Prior Authorization Guide and Appeals Process

Answer Box: Getting Ruconest Covered by Humana in North Carolina Who's eligible: Adults and adolescents with confirmed hereditary angioedema (HAE) experiencing acute attacks. Fastest approval path: 1) Confirm HAE diagnosis with labs (C4, C1-INH levels), 2) Document attack frequency and failed alternatives, 3) Have allergist/immunologist submit prior

How to Get Firazyr (Icatibant) Covered by Humana in North Carolina: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Firazyr Covered by Humana in North Carolina Firazyr (icatibant injection) requires prior authorization from Humana with documented HAE diagnosis, attack history, and specialist prescription. If denied, you have 65 days for internal appeals and 120 days for North Carolina's external review through Smart NC (1-855-408-1212)

How to Get Jynarque (tolvaptan) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Jynarque (tolvaptan) Covered by Aetna CVS Health in North Carolina Jynarque requires prior authorization through CVS Caremark specialty pharmacy with REMS enrollment and documentation of rapidly progressing ADPKD (Mayo Class 1C-1E). If denied, appeal internally within 180 days, then request Smart NC external review within 120 days.

How to Get Acthar Gel Covered by Aetna CVS Health in North Carolina: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Acthar Gel Covered by Aetna CVS Health in North Carolina Acthar Gel requires prior authorization from Aetna CVS Health for all indications. For North Carolina residents, the fastest path to approval involves: (1) Submit a complete PA request with detailed clinical documentation proving corticosteroid failure or contraindications,

How to Get Onpattro (Patisiran) Covered by Cigna in North Carolina: Complete Timeline, Forms & Appeal Guide

Answer Box: Getting Onpattro (Patisiran) Covered by Cigna in North Carolina Eligibility: Adults with hereditary transthyretin amyloidosis polyneuropathy (hATTR-PN) confirmed by genetic testing and neurologist evaluation. Fastest Path: Submit complete prior authorization through Cigna's provider portal with genetic test results, neurologist consultation notes, and mNIS+7 scores. Standard

How to Get Filsuvez (Birch Triterpenes Gel) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Filsuvez Covered by UnitedHealthcare in North Carolina Filsuvez requires prior authorization from UnitedHealthcare/OptumRx for epidermolysis bullosa wound care. To get approval in North Carolina: 1) Gather genetic testing confirming dystrophic or junctional EB, wound documentation, and specialist evaluation, 2) Submit PA request via UnitedHealthcare provider portal

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

Answer Box: Quick Path to Evkeeza Coverage Evkeeza (evinacumab) requires prior authorization from Cigna in North Carolina. To get approved, you need: (1) confirmed homozygous familial hypercholesterolemia diagnosis with genetic testing or clinical criteria, (2) documentation of maximally tolerated statin, ezetimibe, and PCSK9 inhibitor trials (if age ≥10), and (3)

Getting Strimvelis Gene Therapy Covered by Blue Cross Blue Shield in North Carolina: Complete Guide to International Coverage and Appeals

Answer Box: Getting Strimvelis Covered by Blue Cross Blue Shield in North Carolina Strimvelis gene therapy for ADA-SCID is not FDA-approved in the U.S. and requires treatment at San Raffaele Hospital in Milan, Italy. Blue Cross Blue Shield of North Carolina (Blue Cross NC) does not have a specific

How to Get Soliris (Eculizumab) Covered by Humana in North Carolina: Complete Prior Authorization Guide with Appeals Process

Answer Box: Getting Soliris Covered by Humana in North Carolina Humana requires strict prior authorization for Soliris (eculizumab) with specific documentation for FDA-approved conditions. The fastest path: (1) Confirm your diagnosis meets FDA criteria (PNH, aHUS, gMG, or NMOSD) with required labs, (2) Submit complete documentation through CenterWell Specialty Pharmacy

How to Get Ocrevus (Ocrelizumab) Covered by Cigna in North Carolina: Appeals Guide & Forms

Answer Box: Getting Ocrevus Covered by Cigna in North Carolina Fastest path to approval: Submit prior authorization through your neurologist with documented MS diagnosis, prior DMT failure/intolerance, and hepatitis B screening. If denied, file internal appeal within 180 days, then external review through North Carolina's Smart NC