Topic

North Carolina

A collection of 504 issues

Get Humira (Adalimumab) Approved by Blue Cross Blue Shield North Carolina: Complete Forms, Appeals & Contact Guide

Answer Box: Getting Humira Approved by BCBS North Carolina Blue Cross Blue Shield of North Carolina requires prior authorization for Humira (adalimumab) with step therapy through preferred biosimilars first. Submit PA via the Availity Provider Portal or call 800-672-7897. Include clinical documentation of biosimilar failures, diagnosis codes, and medical necessity.

How to Get Alprolix (Factor IX) Covered by Aetna CVS Health in North Carolina: Forms, Appeals, and Success Timeline

Answer Box: Getting Alprolix Covered by Aetna CVS Health in North Carolina Alprolix (eftrenonacog alfa) is excluded from most Aetna formularies, requiring a medical exception request rather than standard prior authorization. Your hematologist must submit comprehensive documentation through Aetna's provider portal or fax to 1-888-267-3277. If denied, North

Get Amondys 45 (Casimersen) Covered by Humana in North Carolina: Complete PA Guide and Appeal Process

Answer Box: Getting Amondys 45 Covered by Humana in North Carolina Yes, Humana covers Amondys 45 (casimersen) with prior authorization for eligible DMD patients. The fastest path to approval: 1. Confirm genetic eligibility: You need documented exon 45-skippable DMD mutation via genetic testing 2. Submit complete PA: Your neurologist submits

How to Get HyperHEP B (Hepatitis B Immune Globulin) Covered by Cigna in North Carolina: Prior Authorization Guide and Appeal Process

Answer Box: Getting HyperHEP B Covered by Cigna in North Carolina HyperHEP B (hepatitis B immune globulin) requires prior authorization from Cigna for post-exposure prophylaxis. In North Carolina, submit PA requests through Cigna's provider portal with exposure documentation, patient immunity status, and CDC-compliant timing (within 24 hours for

Getting Takhzyro (lanadelumab-flyo) Covered by Humana in North Carolina: Complete Guide with Forms and Appeal Scripts

Answer Box: Your Path to Coverage Takhzyro (lanadelumab-flyo) requires prior authorization from Humana in North Carolina. Submit your PA request through Humana's TAD portal or fax forms from your Evidence of Coverage. Include confirmed HAE diagnosis (low C4 and C1-INH levels), attack history documentation, and medical necessity justification.

How to Get Amondys 45 (casimersen) Covered by UnitedHealthcare in North Carolina: Complete PA Guide and Appeal Scripts

Answer Box: Getting Amondys 45 Covered by UnitedHealthcare in North Carolina Amondys 45 (casimersen) requires prior authorization from UnitedHealthcare, with genetic testing confirming DMD amenable to exon 45 skipping as the primary requirement. Submit PA through OptumRx with complete genetic documentation, specialist records, and infusion plan. If denied, appeal within

The Requirements Checklist to Get Poteligeo (mogamulizumab-kpkc) Covered by Blue Cross Blue Shield in North Carolina: Forms, Appeals, and Documentation Guide

Answer Box: Fast Track to Poteligeo Coverage To get Poteligeo (mogamulizumab-kpkc) covered by Blue Cross Blue Shield in North Carolina: 1) Confirm your plan requires prior authorization through the Blue Cross NC provider portal, 2) Submit PA with documented relapsed/refractory mycosis fungoides or Sézary syndrome after ≥1 prior systemic

How to Get Vimizim (Elosulfase Alfa) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Vimizim Covered by UnitedHealthcare in North Carolina Prior authorization is required for Vimizim (elosulfase alfa) through UnitedHealthcare's OptumRx formulary. Submit PA via the UnitedHealthcare Provider Portal with complete MPS IVA diagnosis documentation, GALNS enzyme deficiency confirmation, and medical necessity justification. Standard decisions take 72 hours;

How Long Does It Take to Get Sumavel DosePro Approved by Cigna in North Carolina? Timeline & Appeal Guide

Answer Box: Cigna typically processes Sumavel DosePro (sumatriptan injection, needle-free) prior authorization requests within 2-3 business days through Express Scripts, though the brand has been discontinued in the U.S. You'll need to try at least one oral triptan first due to step therapy requirements. If denied, you

Myths vs. Facts: Getting Krystexxa (Pegloticase) Covered by Humana in North Carolina

Answer Box: Getting Krystexxa Covered by Humana in North Carolina Yes, Humana covers Krystexxa (pegloticase) with prior authorization. Key requirements: chronic gout diagnosis, failed allopurinol (≥300mg/day for 3+ months) plus uricosuric therapy, negative G6PD screen, rheumatologist prescription, and serum uric acid ≥6 mg/dL. Submit requests through Humana'