Topic

North Carolina

A collection of 430 issues

How to Get Garadacimab (Andembry) Covered by UnitedHealthcare in North Carolina: Timeline, Appeals, and Documentation Guide

Answer Box: Getting Garadacimab Covered in North Carolina UnitedHealthcare requires prior authorization for Garadacimab (Andembry) with mandatory step therapy—you must try and fail preferred HAE prophylaxis medications first. Standard approval takes 2-3 business days via OptumRx portal; expedited reviews process within 24-72 hours for urgent cases. If denied, North

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

Answer Box: Getting Tysabri Covered by Aetna CVS Health in North Carolina Tysabri (natalizumab) requires prior authorization from Aetna CVS Health with mandatory TOUCH Prescribing Program enrollment, recent JCV antibody testing, and brain MRI documentation. Submit requests via phone (1-855-582-2025), fax (1-855-330-1716), or mail with complete medical records. If denied,

Getting Tagrisso (Osimertinib) Covered by Blue Cross Blue Shield in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tagrisso Covered by BCBS North Carolina Fastest Path: Tagrisso (osimertinib) requires prior authorization from Blue Cross Blue Shield of North Carolina for EGFR-mutant NSCLC. Your oncologist must document EGFR mutation testing (exon 19 deletion or L858R), disease staging, and any prior TKI failures. Submit PA via CoverMyMeds

How to Get Therakos CELLEX Photopheresis Covered by Blue Cross Blue Shield in North Carolina: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Therakos CELLEX Covered in North Carolina Blue Cross Blue Shield of North Carolina covers Therakos CELLEX photopheresis for FDA-approved uses like cutaneous T-cell lymphoma (CTCL) and steroid-refractory graft-versus-host disease (GVHD), but requires prior authorization. Your doctor submits a PA request through the BCBS NC provider portal with

How to Get Busulfex (Busulfan Injection) Covered by Humana in North Carolina: Forms, Appeals, and Provider Resources

Quick Answer: Getting Busulfex Covered by Humana in North Carolina Busulfex (busulfan injection) typically requires prior authorization through Humana's medical benefit as part of bone marrow transplant conditioning. Start by having your transplant center submit a prior authorization request via Humana's provider portal or CoverMyMeds. Include

Get Trikafta Covered by Cigna in North Carolina: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Trikafta Covered by Cigna in North Carolina Cigna requires prior authorization for Trikafta (elexacaftor/tezacaftor/ivacaftor) with documented cystic fibrosis diagnosis, CFTR genetic testing, and CF specialist prescription. Submit electronically via CoverMyMeds or fax the official Cigna PA form with ICD-10 code E84.0, genetic test results,

Getting Blenrep (Belantamab Mafodotin) Covered by Humana in North Carolina: PA Requirements, Appeals, and Alternative Options

Answer Box: Fast Track to Blenrep Coverage Blenrep (belantamab mafodotin) received FDA approval on October 23, 2025, for relapsed/refractory multiple myeloma after 2+ prior therapies. Humana Medicare typically covers FDA-approved oncology drugs but requires prior authorization. Your fastest path: 1) Have your oncologist submit Humana's "Request

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

Quick Answer: To get Qinlock (ripretinib) covered by Aetna (CVS Health) in North Carolina, you'll need prior authorization showing failure of at least three kinase inhibitors (imatinib, sunitinib, regorafenib) for advanced GIST. Submit requests via Aetna's provider portal or call 1-866-814-5506. Standard decisions take 30 days;

Oxbryta (Voxelotor) Coverage with Humana in North Carolina: What You Need to Know After FDA Withdrawal

Answer Box: Oxbryta (Voxelotor) Coverage Status Oxbryta (voxelotor) is no longer available in the United States. Pfizer voluntarily withdrew the medication from all global markets on September 25-26, 2024, following FDA safety alerts. Humana and other insurers now deny all claims due to loss of FDA approval. If you'

Getting Onivyde (Irinotecan Liposome) Covered by Blue Cross Blue Shield of North Carolina: Complete PA Guide and Appeals Process

Answer Box: Quick Path to Onivyde Coverage Blue Cross Blue Shield of North Carolina requires prior authorization for Onivyde (irinotecan liposome), typically approved for FDA-indicated NALIRIFOX regimen in first-line metastatic pancreatic cancer. Your oncologist submits PA documentation including confirmed diagnosis, performance status, and treatment rationale. If denied, file internal appeal