Topic

North Carolina

A collection of 449 issues

How to Get Galafold (Migalastat) Covered by Blue Cross Blue Shield of North Carolina: Complete Guide to Forms, Appeals, and External Review

Answer Box: Getting Galafold (Migalastat) Covered by Blue Cross Blue Shield of North Carolina Eligibility: Adults with Fabry disease and a confirmed amenable GLA variant documented by genetic testing. Fastest path: Submit prior authorization through the MHK Provider Portal with genetic test results showing amenable mutation and specialist consultation notes.

How to Get Venclexta (venetoclax) Covered by Aetna (CVS Health) in North Carolina: Complete Guide to Prior Authorization, Appeals, and Coding

Quick Answer: Getting Venclexta (venetoclax) Covered by Aetna in North Carolina Venclexta requires prior authorization from Aetna (CVS Health) with step therapy requirements—typically requiring documented failure of ibrutinib and/or rituximab first. Submit your PA request through the CVS Caremark provider portal or via fax with complete clinical documentation,

Do You Qualify for Koselugo Coverage by UnitedHealthcare in North Carolina? Decision Tree & Next Steps

Answer Box: Quick Qualification Check Getting Koselugo (selumetinib) covered by UnitedHealthcare in North Carolina: You'll likely qualify if your child (age 2-18) has confirmed NF1 with symptomatic, inoperable plexiform neurofibromas documented by MRI. First step: Gather baseline LVEF testing, ophthalmologic exam results, and surgical consultation notes confirming inoperability.

How to Get Fintepla (Fenfluramine) Covered by Aetna CVS Health in North Carolina: Appeals Timeline and Medical Necessity Templates

Answer Box: Getting Fintepla Covered by Aetna CVS Health in North Carolina Fastest Path: 1) Ensure REMS enrollment and baseline echocardiogram documentation, 2) Submit prior authorization with evidence of failed standard antiseizure medications (minimum 2), and 3) Include neurologist consultation confirming Dravet syndrome or Lennox-Gastaut syndrome diagnosis. If denied, appeal

Getting Rylaze Approved by Humana in North Carolina: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Started Today Rylaze (asparaginase erwinia chrysanthemi) requires prior authorization from Humana, with approval contingent on documented Grade 2-4 hypersensitivity to E. coli asparaginase. The fastest path: (1) Gather complete allergy documentation and ALL/LBL diagnosis records, (2) Submit PA request through Humana's provider portal with

How to Get Cresemba (Isavuconazole) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Cresemba Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Cresemba (isavuconazole) in North Carolina through OptumRx. You'll need: confirmed invasive aspergillosis (B44.0) or mucormycosis (B46.x) diagnosis, documentation that voriconazole failed/can't be used, and infectious disease specialist consultation.

How to Get Waylivra (Volanesorsen) Covered by Aetna in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Waylivra Covered by Aetna in North Carolina Waylivra (volanesorsen) is not FDA-approved in the US, making Aetna coverage extremely difficult but not impossible. For familial chylomicronemia syndrome (FCS), you'll need genetic confirmation, documented triglyceride levels ≥880 mg/dL, and failure of standard therapies. Your fastest

How to Get Helixate Covered by Cigna in North Carolina: Prior Authorization Forms, Appeals, and State Resources

Answer Box: Getting Helixate Covered by Cigna in North Carolina Helixate requires prior authorization from Cigna and is typically non-formulary, requiring step therapy documentation. Start immediately with your hematologist to complete the Cigna Hemophilia Factor VIII Prior Authorization Form via CoverMyMeds or fax. If denied, you have 180 days for

How to Get Breyanzi (Lisocabtagene Maraleucel) Covered by Cigna in North Carolina: Complete PA Guide and Appeals Process

Quick Answer: Getting Breyanzi Covered by Cigna in North Carolina Breyanzi (lisocabtagene maraleucel) requires prior authorization from Cigna and must be administered at a FACT-accredited facility. The fastest path: 1) Confirm your treatment center has FACT accreditation for immune effector cell therapy, 2) Submit PA through CoverMyMeds or Accredo with

How to Get Lutathera (Lutetium Lu-177 Dotatate) Covered by UnitedHealthcare in North Carolina: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Lutathera Covered by UnitedHealthcare in North Carolina Lutathera requires prior authorization from UnitedHealthcare with strict step therapy requirements. You must show disease progression on octreotide LAR or lanreotide, plus SSTR-positive imaging (Ga-68 DOTATATE PET scan). If denied, appeals succeed in 85% of cases. Start today: Gather your