Topic

North Carolina

A collection of 430 issues

Do You Qualify for Cystadane Coverage by Cigna in North Carolina? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Cystadane Coverage Yes, you likely qualify for Cystadane (betaine anhydrous) coverage by Cigna in North Carolina if you have confirmed homocystinuria with elevated plasma homocysteine (>50-100 µmol/L) and genetic or biochemical confirmation. Most approvals require prior authorization through Express Scripts/Accredo with

Complete Guide to Getting Keppra (Levetiracetam) Covered by UnitedHealthcare in North Carolina: Forms, Appeals, and Medical Necessity Requirements

Answer Box: Fast Track to Keppra Coverage Generic levetiracetam typically requires no prior authorization on UnitedHealthcare plans, while brand Keppra needs PA with documented 4-week generic trial failure. Submit via UHC Provider Portal with seizure logs, prior medication failures, and medical necessity letter. Standard review takes 3-5 business days; expedited

How to Get Mycapssa (Octreotide Oral) Covered by Aetna CVS Health in North Carolina: Appeals, Prior Authorization, and State Protections

Answer Box: Getting Mycapssa Covered by Aetna CVS Health in North Carolina Fastest path to approval: Submit prior authorization through CVS Specialty (1-800-237-2767) with documented acromegaly diagnosis, prior response to injectable octreotide/lanreotide, and medical necessity letter. If denied, file internal appeal within 180 days citing North Carolina step therapy

How to Get Adynovate (bdanocog alfa pegol) Approved by Aetna CVS Health in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Adynovate Approved by Aetna CVS Health in North Carolina Aetna CVS Health requires prior authorization for Adynovate (bdanocog alfa pegol) in North Carolina. Most requests are approved when you submit complete documentation showing hemophilia A diagnosis, factor VIII levels, bleeding history, and medical necessity for extended half-life

How Long Does It Take to Get Symdeko (Tezacaftor/Ivacaftor) Approved by Aetna CVS Health in North Carolina? Complete Timeline Guide

Answer Box: Getting Symdeko Approved by Aetna CVS Health in North Carolina Typical timeline: 1-14 days for standard prior authorization, 24-72 hours for urgent requests. Aetna CVS Health requires prior authorization for Symdeko (tezacaftor/ivacaftor) with documented CF diagnosis, eligible CFTR genotype, and age ≥6 years. Fastest path: Submit complete

How to Get Rapivab (Peramivir) Covered by Blue Cross Blue Shield in North Carolina: Appeals, Forms, and State Protections

Answer Box: Getting Rapivab Covered by Blue Cross Blue Shield in North Carolina Blue Cross Blue Shield of North Carolina requires prior authorization for Rapivab (peramivir), listed under "Prior Review" in their 2024-2025 formularies. To get approval: (1) Submit a PA request via the BCBS NC provider portal

How Long Does It Take to Get Crysvita (burosumab) Approved by Blue Cross Blue Shield of North Carolina? Complete Timeline & Appeals Guide

Answer Box: Fastest Path to Crysvita Coverage in North Carolina Blue Cross Blue Shield of North Carolina typically takes 15 business days for standard Crysvita prior authorization, 72 hours for expedited review. Submit complete PA via Blue e portal with genetic confirmation (PHEX mutation), baseline labs (low serum phosphorus), and

The Requirements Checklist to Get Idelvion (Albutrepenonacog Alfa) Covered by UnitedHealthcare in North Carolina: Prior Authorization, Appeals, and Coding Guide

Answer Box: Getting Idelvion Covered by UnitedHealthcare in North Carolina Idelvion (albutrepenonacog alfa) requires prior authorization under UnitedHealthcare through OptumRx in North Carolina. Your fastest path to approval: (1) Confirm your hemophilia B diagnosis with recent factor IX activity levels and inhibitor testing, (2) Have your hematologist submit a complete

Renewing Waylivra (Volanesorsen) Approval with Humana in North Carolina: Essential Preparation Guide

Quick Answer: Waylivra (volanesorsen) requires annual prior authorization renewal with Humana Medicare Advantage plans. Start the renewal process 30 days before your current approval expires by having your prescriber submit updated clinical documentation showing ongoing medical necessity, treatment response, and safety monitoring. If denied, you have 65 days to appeal

Renewing Duopa (Carbidopa/Levodopa Enteral) Coverage with Cigna in North Carolina: Timeline, Documentation & Appeals

Quick Answer: Renewing Your Duopa Coverage in North Carolina Cigna approves Duopa renewals for 1-year periods when you still meet the original criteria and show continued benefit. Start your renewal 30-45 days before expiration. You'll need: updated neurology notes documenting ongoing advanced Parkinson's with OFF episodes,