Topic

North Carolina

A collection of 504 issues

How to Get Filspari (Sparsentan) Covered by Humana in North Carolina: Complete Guide with Forms, Appeals, and Cost-Saving Strategies

Answer Box: Fastest Path to Filspari Coverage Filspari (sparsentan) is covered by Humana Medicare Advantage plans with prior authorization required. Your nephrologist submits a PA request with IgA nephropathy diagnosis, lab results (proteinuria/eGFR), and medical necessity letter via Humana's provider portal or fax (800-555-2546). Standard approval takes
6 min read

How to Get Pyrukynd (Mitapivat) Covered by Humana in North Carolina: Complete Prior Authorization and Appeals Guide

Getting Pyrukynd (mitapivat) covered by Humana in North Carolina requires prior authorization with genetic confirmation of pyruvate kinase deficiency, prescription by a board-certified hematologist, and documented clinical severity. For denials, commercial Humana plans can use North Carolina's Smart NC external review (120-day deadline), while Medicare Advantage plans follow
5 min read

How to Get Trikafta Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Trikafta Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Trikafta through OptumRx, with approval typically taking 72 hours when complete documentation is provided. Your CF specialist must submit CFTR genotype results showing F508del or another responsive mutation, along with baseline labs and a medical
6 min read

How to Get Orfadin (nitisinone) Covered by Aetna CVS Health in North Carolina: Complete PA Guide with Appeals Timeline

Answer Box: Getting Orfadin (nitisinone) Covered by Aetna CVS Health in North Carolina Aetna CVS Health requires prior authorization for Orfadin (nitisinone) with approval contingent on confirmed hereditary tyrosinemia type 1 (HT-1) diagnosis, elevated succinylacetone levels, and documented dietary management. Standard decisions take 72 hours; expedited requests get 24-hour responses.
5 min read

How to Get Helixate (Antihemophilic Factor, rFVIII) Covered by Blue Cross Blue Shield of North Carolina: Complete PA Guide and Appeal Scripts

Answer Box: Getting Helixate Covered by BCBS North Carolina Blue Cross Blue Shield of North Carolina requires prior authorization for Helixate (antihemophilic factor, rFVIII) as a specialty medication. Fastest path to approval: 1) Confirm your hematologist will prescribe through BCBSNC's Hemophilia Network pharmacy, 2) Submit PA with hemophilia
6 min read

How to Get Mavenclad (cladribine tablets) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Mavenclad Covered in North Carolina UnitedHealthcare requires prior authorization for Mavenclad (cladribine tablets) for relapsing MS, with no explicit step therapy but strict criteria including lymphocyte count ≥800 cells/μL and documented prior DMT failure. If denied, you have 180 days for internal appeals, then 120 days
6 min read

Blue Cross Blue Shield North Carolina's Coverage Criteria for Naglazyme (Galsulfase): Complete Prior Authorization Guide

Answer Box: Getting Naglazyme Covered by Blue Cross Blue Shield of North Carolina Blue Cross Blue Shield of North Carolina requires prior authorization for Naglazyme (galsulfase) with confirmed MPS VI diagnosis via enzyme assay or genetic testing. Submit complete documentation including baseline functional assessments (6-minute walk test, stair climbing) through
7 min read

Getting Entresto Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Approval UnitedHealthcare requires prior authorization for Entresto (sacubitril/valsartan) in North Carolina. To get approved: Your cardiologist must document heart failure with LVEF ≤40%, NYHA Class II-IV symptoms, and prior ACE inhibitor/ARB trial or intolerance. Submit through UnitedHealthcare Provider Portal with recent echocardiogram, clinical
5 min read