Topic

North Carolina

A collection of 447 issues

Do You Qualify for Hetlioz (Tasimelteon) Coverage by Cigna in North Carolina? Decision Tree & Next Steps

Answer Box: Qualifying for Hetlioz (Tasimelteon) Coverage You likely qualify for Cigna coverage of Hetlioz (tasimelteon) in North Carolina if you have: * Confirmed Non-24-Hour Sleep-Wake Disorder or Smith-Magenis Syndrome diagnosis * Sleep specialist evaluation with 14+ days of sleep logs/actigraphy * Documentation of failed alternative treatments (if step therapy applies) Fastest

Getting Elzonris (Tagraxofusp-erzs) Covered by Humana in North Carolina: Complete Coding, Prior Authorization & Appeals Guide

Answer Box: Get Elzonris Covered by Humana in 3 Steps Elzonris (tagraxofusp-erzs) requires prior authorization from Humana Medicare Advantage plans in North Carolina. Fastest path to approval: 1) Gather BPDCN pathology with CD123-positive immunophenotype and baseline albumin ≥3.2 g/dL, 2) Submit PA request via Humana provider portal using

How to Get Zolgensma Covered by Blue Cross Blue Shield in North Carolina: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Zolgensma Covered in North Carolina Fastest path to approval: Submit Blue Cross Blue Shield's prior authorization with genetic confirmation (bi-allelic SMN1 mutation), AAV9 antibody titers ≤1:50, and complete steroid protocol plan. If denied, file internal appeal within plan deadlines, then request external review through

How Long Does It Take to Get Gattex (Teduglutide) Approved by Cigna in North Carolina? Complete Timeline Guide

Quick Answer: Cigna typically processes Gattex (teduglutide) prior authorization requests within 2 business days for standard cases, 24 hours for urgent situations. In North Carolina, if denied, you have 180 days for internal appeals and 120 days for Smart NC external review. Start by having your gastroenterologist submit complete parenteral

Myths vs. Facts: Getting Tremfya (Guselkumab) Covered by Humana in North Carolina

Answer Box: Getting Tremfya Covered by Humana in North Carolina Eligibility: Moderate-to-severe plaque psoriasis with PASI ≥10 or equivalent severity, failed conventional systemic therapy (methotrexate, cyclosporine), and negative TB screening within 12 months. Fastest path: Work with a dermatologist to submit prior authorization with complete documentation: diagnosis severity scores, prior

How to Get Pombiliti (cipaglucosidase alfa-atga) Covered by Aetna CVS Health in North Carolina: Timeline, Appeals & Documentation Guide

Answer Box: Getting Pombiliti Covered by Aetna CVS Health in North Carolina Pombiliti (cipaglucosidase alfa-atga) requires prior authorization from Aetna CVS Health with strict documentation requirements. The fastest path to approval: (1) Confirm diagnosis of late-onset Pompe disease with enzyme/genetic testing, (2) Document inadequate response to prior ERT therapy,

Myths vs. Facts: Getting Orfadin (nitisinone) Covered by Humana in North Carolina

Answer Box: Fast Track to Orfadin Coverage Myth: Your doctor's prescription guarantees coverage. Fact: Humana requires prior authorization with specific documentation for Orfadin (nitisinone). In North Carolina, you have strong appeal rights through Smart NC external review if initially denied. Fastest path: Have your prescriber submit PA with

Renewing Xembify Approval with UnitedHealthcare in North Carolina: 2025 Requirements and Timeline

Answer Box: Renewing Xembify Coverage with UnitedHealthcare in North Carolina Start your Xembify renewal 60-90 days before expiration. UnitedHealthcare typically requires annual reauthorization with updated IgG levels, infection documentation, and clinical response evidence. Submit through the UnitedHealthcare Provider Portal with current labs and provider attestation. If coverage lapses, request expedited

How to Get Firdapse (Amifampridine) Covered by UnitedHealthcare in North Carolina: Complete Guide with Appeals Process and State Protections

Answer Box: Getting Firdapse Covered in North Carolina UnitedHealthcare requires prior authorization for Firdapse (amifampridine) in North Carolina. Your fastest path to approval: (1) Have your neurologist submit a complete PA request with confirmed LEMS diagnosis (EMG showing >60% increment, P/Q-type VGCC antibodies), clinical documentation of functional impairment,

How to Get Brensocatib (BRINSUPRI) Covered by Blue Cross Blue Shield of North Carolina: Complete Prior Authorization Guide 2025

Answer Box: Getting Brensocatib (BRINSUPRI) Covered in North Carolina To get Brensocatib (BRINSUPRI) covered by Blue Cross Blue Shield of North Carolina: Submit a prior authorization request documenting failed macrolide therapy (azithromycin/clarithromycin) and airway clearance treatment, plus at least 2 exacerbations requiring antibiotics in the past year (1 for