Topic

North Carolina

A collection of 449 issues

UnitedHealthcare's Coverage Criteria for Rinvoq (upadacitinib) in North Carolina: What Counts as "Medically Necessary"?

Answer Box: Getting Rinvoq Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Rinvoq (upadacitinib) with mandatory step therapy—patients must fail at least one TNF inhibitor first. To get approved: 1) Have your specialist document TNF inhibitor failure/intolerance, 2) Submit PA through OptumRx with complete medical

How to Get Myozyme (Alglucosidase Alfa) Covered by Humana in North Carolina: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Myozyme Covered by Humana in North Carolina Humana requires prior authorization for Myozyme (alglucosidase alfa) in North Carolina. Your fastest path to approval: (1) Have your prescriber submit a complete PA request with Pompe disease diagnosis, enzyme/genetic testing results, and clinical rationale via Humana's

How to Get Zolgensma Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Zolgensma Covered by Aetna CVS Health in North Carolina Zolgensma requires strict prior authorization from Aetna CVS Health. Your child must be under 24 months old with confirmed bi-allelic SMN1 mutations and anti-AAV9 antibody titers ≤1:50. Submit complete documentation to CVS Specialty at 1-888-267-3277. Standard decisions

Getting Rinvoq (upadacitinib) Covered by Cigna in North Carolina: Complete Guide with Appeal Forms and State Protections

Answer Box: Getting Rinvoq (upadacitinib) Covered by Cigna in North Carolina Eligibility: Cigna requires prior authorization for Rinvoq with step therapy requirements (failed TNF inhibitors or DMARDs). Fastest path: Submit complete clinical documentation showing prior therapy failures through Cigna's provider portal or formulary exception process. First step today:

Getting Trikafta Approved by Humana in North Carolina: Complete Coverage Guide with Appeals Process

Quick Answer: Do You Qualify for Trikafta Coverage by Humana in North Carolina? Most likely yes, if you have: Confirmed cystic fibrosis with at least one F508del CFTR mutation (or other responsive mutation), age 2+, and recent liver function tests. Fastest path: Your CF specialist submits prior authorization with genetic

How to Get Vanflyta (Quizartinib) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Vanflyta Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Vanflyta (quizartinib) through OptumRx, with specific documentation of FLT3-ITD positivity and cardiac monitoring. The fastest path to approval: (1) Submit complete PA request via UnitedHealthcare Provider Portal with FLT3-ITD test results and EKG showing QTc

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

Quick Answer: Getting Oxervate Approved by Aetna CVS Health in North Carolina Eligibility: Stage 2 or 3 neurotrophic keratitis with documented corneal sensitivity loss and failed artificial tears trial (≥14 days). Fastest path: Ophthalmologist submits prior authorization through CVS Caremark with complete clinical documentation including corneal sensitivity testing results. First

How to Get Bylvay (odevixibat) Covered by Blue Cross Blue Shield of North Carolina: Complete Guide to Prior Authorization, Appeals, and External Review

Answer Box: Fast Track to Bylvay Coverage in North Carolina Bylvay (odevixibat) requires prior authorization from Blue Cross Blue Shield of North Carolina and is placed on Tier 4 (specialty tier). The fastest path to approval: (1) Have your hepatologist submit a comprehensive prior authorization request through the BCBS NC

How to Get Brensocatib (BRINSUPRI) Covered by Cigna in North Carolina: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Brensocatib (BRINSUPRI) Covered by Cigna in North Carolina Eligibility: Adults and teens ≥12 years with bronchiectasis confirmed by CT scan, plus 1-2 pulmonary exacerbations requiring antibiotics in the past year (age-dependent). Fastest path: Have your pulmonologist submit prior authorization through CoverMyMeds or directly to Cigna, including exacerbation

Getting Cimzia (Certolizumab Pegol) Covered by Cigna in North Carolina: Complete Prior Authorization Guide

Quick Answer: Cigna Coverage for Cimzia in North Carolina Cigna requires prior authorization for Cimzia (certolizumab pegol) in North Carolina. You'll need: (1) FDA-approved diagnosis like Crohn's disease or rheumatoid arthritis, (2) documented failure/intolerance to conventional therapies and usually one preferred TNF inhibitor, and (3)