Topic

North Carolina

A collection of 54 issues

Work With Your Doctor to Get Eylea and Lucentis Covered by Cigna in North Carolina: Complete Appeals Guide

Answer Box: Getting Eylea/Lucentis Covered by Cigna in North Carolina Eligibility: Cigna covers Eylea (aflibercept) and Lucentis (ranibizumab) for wet AMD, diabetic macular edema, and other retinal conditions, but requires prior authorization and typically step therapy with bevacizumab first. Fastest Path: Your ophthalmologist submits a prior authorization through Cigna&

How to Get Kuvan (Sapropterin) Covered by UnitedHealthcare in North Carolina: Forms, Appeals & Resources

Answer Box: Getting Kuvan Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Kuvan (sapropterin dihydrochloride) with specific medical necessity criteria. Your fastest path to approval: (1) Confirm your PKU diagnosis and phenylalanine-restricted diet documentation, (2) Submit the OptumRx prior authorization form through the UnitedHealthcare Provider Portal, and

How to Get Tavalisse (Fostamatinib) Covered by Cigna in North Carolina: Prior Authorization Guide with Appeals Process

Quick Answer: Getting Tavalisse Covered by Cigna in North Carolina Tavalisse (fostamatinib) requires prior authorization from Cigna for chronic ITP treatment. You'll need documented failure of at least one prior therapy (steroids, IVIG, or TPO receptor agonists), hematologist involvement, and baseline labs. The fastest path: have your hematologist

How to Get Lutathera (Lutetium Lu-177 Dotatate) Covered by Aetna CVS Health in North Carolina: Forms, Appeals, and Cost-Saving Strategies

Answer Box: Getting Lutathera Covered by Aetna CVS Health in North Carolina Aetna requires prior authorization for Lutathera (lutetium Lu-177 dotatate) with strict criteria for somatostatin receptor-positive GEP-NETs. Your fastest path: Have your oncologist submit complete documentation (diagnosis, SSTR+ imaging, prior therapy failures) via Aetna's provider portal. Standard

Renewing Exondys 51 (Eteplirsen) Approval with UnitedHealthcare in North Carolina: 2025 Requirements & Timeline

Answer Box: Renewing Your Exondys 51 Coverage Quick Answer: UnitedHealthcare requires annual renewal of Exondys 51 (eteplirsen) prior authorization with updated clinical documentation. Start the renewal process 60-90 days before your current authorization expires. You'll need: neurologist evaluation showing continued benefit, updated cardiac/renal function tests, and proof

How to Get Busulfex (Busulfan Injection) Covered by Blue Cross Blue Shield of North Carolina: Forms, Appeals, and State Protections

Quick Answer: Getting Busulfex Covered in North Carolina Busulfex (busulfan injection) requires prior authorization with Blue Cross Blue Shield of North Carolina for most plans. Submit PA requests via the Blue E portal with comprehensive clinical documentation including diagnosis, prior therapies, and transplant conditioning rationale. If denied, you have 180

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

Answer Box: Keppra Coverage by Blue Cross Blue Shield in North Carolina Good news: Generic levetiracetam (Keppra) is covered on Blue Cross NC's 2024 formularies without prior authorization. Brand-name Keppra requires medical necessity documentation showing generic failure or intolerance. If denied, appeal internally first, then request external review

Get Fintepla (Fenfluramine) Covered by Blue Cross Blue Shield in North Carolina: Complete Guide

Answer Box: Getting Fintepla Approved by BCBS North Carolina Fintepla (fenfluramine) is covered by Blue Cross Blue Shield North Carolina but requires prior authorization and REMS enrollment. Here's your fastest path to approval: 1. Enroll in REMS program - Both patient and prescriber must complete enrollment at FinteplarREMS.

How to Get Alecensa (alectinib) Covered by Cigna in North Carolina: Complete Appeals Guide

Answer Box: Getting Alecensa (alectinib) Covered by Cigna in North Carolina Eligibility: Cigna covers Alecensa for ALK-positive non-small cell lung cancer with prior authorization. Fastest approval path: Submit PA with ALK test results, diagnosis codes, and clinical notes through CoverMyMeds or fax to 1-866-873-8279. First step today: Gather your ALK

How to Renew Fintepla (Fenfluramine) Coverage with Cigna in North Carolina: 2025 Requirements & Timelines

Answer Box: Renewing Fintepla Coverage with Cigna in North Carolina Cigna requires annual prior authorization renewal for Fintepla (fenfluramine) with mandatory REMS compliance and echocardiography documentation. Start your renewal 60-90 days before expiration. You'll need: current REMS enrollment, echocardiogram results (required every 6 months), seizure frequency logs showing