Topic

North Carolina

A collection of 504 issues

How to Get Tavneos (Avacopan) Covered by Aetna CVS Health in North Carolina: Complete Guide to Prior Authorization, Appeals, and Alternative Pathways

Answer Box: Your Path to Coverage Getting Tavneos (avacopan) covered by Aetna CVS Health in North Carolina requires prior authorization with documentation of severe active ANCA-associated vasculitis (GPA/MPA), use alongside standard therapies (rituximab/cyclophosphamide), and specialist prescribing. If denied, you have 180 days for internal appeals, then 120 days

How to Get Myalept (Metreleptin) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Myalept Covered by Aetna CVS Health in North Carolina Myalept (metreleptin) requires precertification from Aetna CVS Health, with initial approval needing confirmed generalized lipodystrophy diagnosis, leptin deficiency (<12 ng/mL), and at least one metabolic complication. If denied, North Carolina residents can appeal internally through Aetna

How to Get Opzelura (Ruxolitinib Cream) Covered by Humana in North Carolina: Step Therapy, Appeals, and Formulary Exception Guide

Answer Box: Getting Opzelura (Ruxolitinib Cream) Covered by Humana in North Carolina Humana does not cover Opzelura (ruxolitinib cream) on its standard Medicare Advantage or Part D formularies, requiring a formulary exception for approval. To succeed, you'll need documented failure of covered alternatives like tacrolimus ointment, Elidel (pimecrolimus)

How to Get Cometriq (Cabozantinib) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Cometriq Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Cometriq (cabozantinib capsules) in North Carolina, primarily for progressive, metastatic medullary thyroid cancer (MTC). Submit PA through your oncologist via the UHC Provider Portal with pathology reports, imaging showing progression, and ICD-10 codes. If denied,

StrataGraft Coverage by Humana in North Carolina: Prior Authorization Guide, Appeals Process, and Decision Tree

Answer Box: StrataGraft Coverage by Humana in North Carolina StrataGraft requires prior authorization for Humana Medicare Advantage coverage in North Carolina, with approval typically taking 15 business days for adults with deep partial-thickness thermal burns when properly documented. The fastest path to approval: (1) Have your burn center submit a

How to Get Rylaze (asparaginase erwinia chrysanthemi [recombinant]-rywn) Covered by Aetna (CVS Health) in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Rylaze Covered by Aetna in North Carolina Aetna requires prior authorization for Rylaze (asparaginase erwinia chrysanthemi [recombinant]-rywn) in North Carolina patients ≥1 month old with ALL/LBL who developed hypersensitivity to E. coli asparaginase. Submit PA through Aetna's provider portal with documented hypersensitivity reactions,

If Jakafi Isn't Approved by Aetna (CVS Health) in North Carolina: Formulary Alternatives & Exception Paths

Quick Answer: Your Options When Aetna Denies Jakafi If Aetna (CVS Health) denies Jakafi (ruxolitinib) in North Carolina, you have three main paths: try formulary alternatives like IBTROZI (ropeginterferon alfa-2b), request a formulary exception with medical necessity documentation, or appeal the denial through Aetna's internal process followed by

How to Get Synagis (Palivizumab) Covered by Blue Cross Blue Shield in North Carolina: Complete PA Guide and Appeals Process

Answer Box: Getting Synagis Covered by Blue Cross Blue Shield in North Carolina Synagis (palivizumab) requires prior authorization from Blue Cross Blue Shield of North Carolina for high-risk infants during RSV season (September-March). Submit the RSV Prophylaxis fax form with NICU records, cardiology/pulmonology consults, and gestational age documentation. If

How to Get Carbaglu (Carglumic Acid) Covered by UnitedHealthcare in North Carolina: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Carbaglu Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Carbaglu (carglumic acid) with 12-month approval periods. Key requirements include documented NAGS deficiency diagnosis, elevated ammonia levels, and metabolic specialist oversight. If denied, you have 180 days to appeal internally, then 120 days to request

How to Get Evrysdi (Risdiplam) Covered by Humana in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Evrysdi Covered by Humana in North Carolina Humana requires prior authorization for Evrysdi (risdiplam) with genetic confirmation of SMA, motor function assessments, and specialist documentation. Submit via Humana's provider portal with complete clinical records for 72-hour standard review (24-hour expedited if urgent). If denied, you