Topic

North Carolina

A collection of 452 issues

How to Get Tremfya (guselkumab) Covered by Cigna in North Carolina: Renewal Guide, Appeals, and Timeline

Answer Box: Renewing Tremfya (guselkumab) with Cigna in North Carolina Cigna requires documented clinical benefit after 6+ months of Tremfya use for renewal authorization, typically approved for 12 months. Submit renewal requests 30-60 days before expiration with objective disease measures (PASI score for psoriasis, joint counts for psoriatic arthritis) and

How Long Does It Take to Get Ultomiris (ravulizumab) Approved by Humana in North Carolina? Complete Timeline Guide

Quick Answer: Humana typically approves complete Ultomiris prior authorizations within 1 business day for electronic submissions, but missing REMS enrollment or vaccination records can delay approval by weeks. Start by ensuring your prescriber is enrolled in the UltSolREMS program and you've received both MenACWY and MenB vaccines at

How to Get Aldurazyme (Laronidase) Covered by Blue Cross Blue Shield in North Carolina: Complete Appeals Guide with Forms and Deadlines

Answer Box: Getting Aldurazyme Covered by Blue Cross Blue Shield in North Carolina Aldurazyme (laronidase) requires prior authorization from Blue Cross Blue Shield of North Carolina. Success depends on documented MPS I diagnosis via enzymatic testing and genetic confirmation. If denied, you have 120 days to file an external review

Get Voydeya (Danicopan) Approved by UnitedHealthcare in North Carolina: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Voydeya Covered by UnitedHealthcare in North Carolina Voydeya (danicopan) requires prior authorization from UnitedHealthcare for coverage as an add-on therapy to C5 inhibitors (eculizumab or ravulizumab) in adults with paroxysmal nocturnal hemoglobinuria (PNH) experiencing extravascular hemolysis. Your fastest path to approval: Have your hematologist submit a prior

How to Get Lumizyme (Alglucosidase Alfa) Covered by Humana in North Carolina: Prior Authorization, Appeals, and Success Strategies

Answer Box: Getting Lumizyme Covered by Humana in North Carolina Lumizyme (alglucosidase alfa) requires prior authorization from Humana for Pompe disease patients in North Carolina. Success depends on three critical elements: (1) confirmed GAA enzyme deficiency plus genetic testing showing two pathogenic GAA gene variants, (2) prescription from a qualified

How to Get Cosentyx (Secukinumab) Covered by UnitedHealthcare in North Carolina: Appeals Guide & Success Strategies

Answer Box: Getting Cosentyx Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Cosentyx (secukinumab) with specific documentation of treatment failures and medical necessity. The fastest path: Have your dermatologist or rheumatologist submit a complete PA request with detailed records of failed first-line therapies. If denied, you have

Natpara (Parathyroid Hormone) Approval with Aetna CVS Health in North Carolina: Complete Coverage Guide

Quick Answer: Getting Natpara Covered by Aetna CVS Health in North Carolina Critical Update: Takeda has permanently discontinued Natpara manufacturing. The U.S. Special Use Program ends December 31, 2025, with no further shipments available. Patients must transition to alternative therapies before this deadline. For existing patients or those seeking

Work With Your Doctor to Get Haegarda Approved by Aetna CVS Health in North Carolina: Forms, Appeals, and Scripts

Answer Box: Fastest Path to Haegarda Coverage To get Haegarda (C1-esterase inhibitor, SC) covered by Aetna CVS Health in North Carolina: Your doctor must submit a prior authorization with lab-confirmed HAE diagnosis (low C4, abnormal C1-INH levels), specialist consultation, and medical necessity documentation. If denied, you have 180 days for

How to Get Besponsa (Inotuzumab Ozogamicin) Covered by Humana in North Carolina: Complete Guide to Prior Authorization, Appeals, and Billing Codes

Answer Box: Getting Besponsa Covered by Humana in North Carolina Besponsa (inotuzumab ozogamicin) requires prior authorization through Evolent/New Century Health for all Humana Medicare Advantage plans. Submit requests via their portal at my.newcenturyhealth.com or call 844-926-4528 (option 5). Required documentation includes CD22-positive B-cell ALL diagnosis (ICD-10: C91.

How to Get Mavenclad (Cladribine) Covered by Humana in North Carolina: Complete Prior Authorization Guide

Answer Box: Your Path to Mavenclad Coverage Mavenclad (cladribine tablets) requires prior authorization from Humana and is subject to step therapy requirements. In North Carolina, you have 65 days to appeal denials through Humana's internal process, then 120 days to file external review with Smart NC. First step