Topic

North Carolina

A collection of 449 issues

Get Orfadin (Nitisinone) Covered by Blue Cross Blue Shield in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Orfadin Covered by Blue Cross Blue Shield in North Carolina Orfadin (nitisinone) is not on BCBS North Carolina's standard formulary, requiring prior authorization for hereditary tyrosinemia type 1. To get coverage: 1) Submit PA with genetic/biochemical HT-1 confirmation and dietary management plan, 2) If

How to Get Rapivab (Peramivir) Covered by Aetna CVS Health in North Carolina: Appeals, Forms, and Timeline Guide

Quick Answer: Getting Rapivab (Peramivir) Covered by Aetna CVS Health in North Carolina Rapivab requires prior authorization under Aetna CVS Health plans in North Carolina and must be filled through specialty pharmacy. To get coverage: 1) Submit PA request with documentation showing flu symptoms ≤48 hours and why oral antivirals

How to Get Arikayce Covered by Blue Cross Blue Shield in North Carolina: Complete Prior Authorization Guide with Appeal Templates

Answer Box: Getting Arikayce Covered by Blue Cross Blue Shield in North Carolina Arikayce (amikacin liposome inhalation) requires prior authorization from Blue Cross Blue Shield of North Carolina for treatment-refractory MAC lung disease. Fastest path: 1) Confirm 6+ months of documented MAC therapy failure, 2) Submit PA through BCBS NC

How to Renew Tysabri (Natalizumab) Coverage with UnitedHealthcare in North Carolina: Evidence Package & Timeline Guide

Answer Box: Renewing Tysabri Coverage with UnitedHealthcare in North Carolina UnitedHealthcare requires annual prior authorization renewal for Tysabri (natalizumab) with specific evidence: recent MRI results, current JCV antibody testing, comprehensive neurologist documentation, and ongoing TOUCH program enrollment. Start renewal 60-90 days before expiration. If denied, North Carolina's Smart

How to Get HyperHEP (Hepatitis B Immune Globulin) Covered by Humana in North Carolina: Prior Authorization, Appeals, and Success Strategies

Answer Box: Getting HyperHEP Covered by Humana in North Carolina HyperHEP (hepatitis B immune globulin) requires prior authorization from Humana and may not be on standard formularies. For coverage in North Carolina: (1) Have your provider submit a prior authorization with exposure documentation within 24-72 hours, (2) If denied, file

How to Get Cerezyme (Imiglucerase) Covered by Cigna in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Cerezyme (Imiglucerase) Covered by Cigna in North Carolina Yes, Cigna covers Cerezyme (imiglucerase) for Type 1 Gaucher disease with prior authorization. Your fastest path to approval requires: (1) confirmed Gaucher disease Type 1 diagnosis with enzyme testing and genetic confirmation, (2) specialist prescriber (hematologist/geneticist), and (3)

Coding That Helps Get Uptravi (selexipag) Approved by Aetna (CVS Health) in North Carolina: ICD-10, J-Codes & NDC Requirements

Answer Box Getting Uptravi (selexipag) covered by Aetna (CVS Health) in North Carolina requires precise coding and comprehensive documentation. Use ICD-10 codes I27.0 (primary PAH) or I27.21 (secondary PAH) with WHO Group I confirmation via right heart catheterization. Bill IV formulations using J3490 + NDC on medical benefit; oral

How to Get Tepezza (Teprotumumab) Covered by Blue Cross Blue Shield in North Carolina: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Tepezza Covered by BCBS in North Carolina Tepezza (teprotumumab) requires prior authorization from Blue Cross Blue Shield of North Carolina for thyroid eye disease coverage. Your fastest path to approval: 1) Gather comprehensive TED documentation including Clinical Activity Score (CAS ≥3), proptosis measurements, and prior therapy failures;

How to Get Vitrakvi (Larotrectinib) Covered by Humana in North Carolina: Complete PA Guide and Appeal Process

Answer Box: Getting Vitrakvi Covered by Humana in North Carolina Vitrakvi (larotrectinib) requires prior authorization through Humana Medicare Advantage plans in North Carolina. To secure coverage: (1) Confirm NTRK gene fusion with FDA-approved testing, (2) Submit complete PA documentation including pathology report and oncologist letter, (3) Use Humana's

Myths vs. Facts: Getting Evrysdi (Risdiplam) Covered by Blue Cross Blue Shield in North Carolina

Answer Box: Evrysdi Coverage in North Carolina Myth: If your doctor prescribes Evrysdi, Blue Cross Blue Shield automatically covers it. Fact: Prior authorization is required with specific documentation including genetic testing, baseline motor assessment, and medical necessity justification. To get started: (1) Confirm your Blue Cross NC plan's