Topic

North Carolina

A collection of 449 issues

Myths vs. Facts: Getting Brineura (Cerliponase Alfa) Covered by Humana in North Carolina

Answer Box: Getting Brineura Covered by Humana in North Carolina Eligibility: Brineura requires prior authorization from Humana for all plans. You need confirmed CLN2 disease (enzyme + genetic testing), age ≥3 years, ambulatory status, and treatment at a qualified center like UNC's Batten Disease Center of Excellence. Fastest path:

Work With Your Doctor to Get Tecentriq (atezolizumab) Covered by Cigna in North Carolina: Complete Provider Collaboration Guide

Answer Box: Getting Tecentriq Covered by Cigna in North Carolina Tecentriq (atezolizumab) requires prior authorization from Cigna, which reviews requests through eviCore healthcare within 72 hours for standard cases or 24 hours for urgent cancer situations. Your oncologist must document diagnosis, PD-L1 testing results (when required), prior therapies, and NCCN

Do You Qualify for Ultomiris Coverage by Blue Cross Blue Shield in North Carolina? Complete Decision Tree & Appeals Guide

Quick Answer: To get Ultomiris (ravulizumab) covered by Blue Cross Blue Shield in North Carolina, you need: (1) confirmed diagnosis with required lab tests (flow cytometry for PNH, antibody testing for myasthenia gravis/NMOSD), (2) meningococcal vaccination completed 2+ weeks before treatment, and (3) prior authorization through your provider'

Get Gilenya (Fingolimod) Covered by Blue Cross Blue Shield of North Carolina: Prior Authorization Forms, Appeals, and Success Strategies

Answer Box: Getting Gilenya Covered in North Carolina Blue Cross Blue Shield of North Carolina requires prior authorization for Gilenya (fingolimod), typically with step therapy requirements. To get approved: (1) Have your doctor submit a PA request with documentation of failed first-line MS therapies, (2) Include required monitoring plans (EKG,

How to Get Retevmo (selpercatinib) Covered by UnitedHealthcare in North Carolina: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Retevmo Covered by UnitedHealthcare in North Carolina Fastest path to approval: Submit prior authorization with FDA-approved RET fusion test results, diagnosis documentation, and prior therapy history through UnitedHealthcare's provider portal. If denied, North Carolina law provides strong step therapy exception rights (72-hour response required) and

How to Get Tracleer (Bosentan) Covered by Humana in North Carolina: Complete Decision Tree and Appeals Guide

Answer Box: Quick Eligibility Check Most likely to get Tracleer (bosentan) covered by Humana in North Carolina: You have WHO Group 1 pulmonary arterial hypertension confirmed by right heart catheterization (mPAP ≥25 mmHg, PCWP ≤15 mmHg, PVR >3 Wood units), your prescriber is enrolled in the REMS program, and

How to Get Tysabri (Natalizumab) Covered by Blue Cross Blue Shield of North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Tysabri Covered by BCBS North Carolina Eligibility: Tysabri (natalizumab) requires prior authorization from Blue Cross Blue Shield of North Carolina for both commercial and Medicare members. Coverage is typically approved for relapsing multiple sclerosis when step therapy requirements are met and proper clinical documentation is provided. Fastest

Blue Cross Blue Shield North Carolina Coverage Criteria for Tecentriq (Atezolizumab): Complete Prior Authorization Guide

Answer Box: Getting Tecentriq Covered by BCBS North Carolina Tecentriq (atezolizumab) requires prior authorization from Blue Cross Blue Shield of North Carolina for all plan types. To get approved: (1) Submit PA request with FDA-approved indication, clinical notes, and required biomarker testing (PD-L1 for NSCLC), (2) Document any prior therapy

Work With Your Doctor to Get Defitelio (Defibrotide) Approved by Aetna (CVS Health) in North Carolina: Provider Partnership Guide

Answer Box: Getting Defitelio Covered by Aetna in North Carolina Who's eligible: Patients with hepatic veno-occlusive disease (VOD) with organ dysfunction after stem cell transplant meeting FDA criteria. Fastest approval path: Your transplant specialist submits prior authorization with complete clinical documentation showing VOD diagnosis and organ dysfunction. Start

Getting iLink® Corneal Cross-Linking Covered by UnitedHealthcare in North Carolina: Complete Appeals Guide

Quick Answer: Your Path to Coverage UnitedHealthcare commercial plans in North Carolina cover iLink® corneal cross-linking for progressive keratoconus when medical necessity criteria are met. Start with a prior authorization request through your ophthalmologist, including corneal topography showing progression and documentation of failed conservative treatments. If denied, you have 180