Topic

North Carolina

A collection of 54 issues

Blue Cross Blue Shield North Carolina Coverage Criteria for Jakafi (Ruxolitinib): Complete Prior Authorization Guide

Answer Box: Getting Jakafi Covered by Blue Cross Blue Shield NC Jakafi (ruxolitinib) requires prior authorization from Blue Cross Blue Shield of North Carolina and must be filled at an in-network specialty pharmacy. To get approved: 1. Submit comprehensive PA request with diagnosis documentation (myelofibrosis, polycythemia vera, or GVHD), prior

How to Get Oxlumo (lumasiran) Covered by Humana in North Carolina: Complete Appeals Guide

Answer Box: Getting Oxlumo Covered by Humana in North Carolina Humana requires prior authorization for Oxlumo (lumasiran) with strict PH1 diagnosis requirements. Your fastest path: 1) Confirm genetic AGXT testing or liver enzyme analysis showing PH1, 2) Get specialist (nephrologist/endocrinologist) involvement, 3) Submit prior authorization with urinary oxalate levels.

How to Get Thiola / Thiola EC (tiopronin) Covered by Cigna in North Carolina: Complete Requirements Guide

Answer Box: Getting Thiola/Thiola EC Covered by Cigna in North Carolina Cigna requires prior authorization for Thiola/Thiola EC (tiopronin) with step therapy requirements. Your fastest path to approval: 1) Gather documentation showing failed conservative treatments (hydration, alkalinization), elevated urine cystine levels (>300-400 mg/24h), and confirmed cystinuria

How to Get Cabometyx (Cabozantinib) Covered by Blue Cross Blue Shield in North Carolina: Coding, Appeals, and Success Strategies

Quick Answer: Blue Cross Blue Shield of North Carolina requires prior authorization for Cabometyx (cabozantinib) across all plan types as of 2024. Your fastest path to approval: have your oncologist submit a PA request with proper ICD-10 codes (C64 for kidney cancer, C22.0 for liver cancer, C73 for thyroid

How to Get Busulfex (busulfan injection) Covered by Aetna in North Carolina: Complete Guide to Appeals and Prior Authorization

Quick Answer: Getting Busulfex Covered by Aetna in North Carolina Yes, Busulfex (busulfan injection) requires prior authorization from Aetna in North Carolina. Submit your PA request at least 2 weeks before your scheduled transplant through the Availity provider portal. If denied, you have 180 days to appeal internally with Aetna,

How to Get Epidiolex (Cannabidiol) Covered by UnitedHealthcare in North Carolina: Appeals, Alternatives & Exception Paths

Answer Box: Getting Epidiolex Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Epidiolex (cannabidiol) with different criteria based on your seizure disorder. For Dravet syndrome or tuberous sclerosis complex, approval may be granted based on diagnosis alone. For Lennox-Gastaut syndrome, you must document failed trials of two

Get iLink® Corneal Cross-Linking Covered by Cigna in North Carolina: Forms, Appeals & Smart NC Guide

Quick Answer: Getting iLink® Covered by Cigna in North Carolina Cigna covers iLink® corneal cross-linking for progressive keratoconus when medical necessity criteria are met. Your fastest path: have your ophthalmologist submit prior authorization through CoverMyMeds with documentation of disease progression (serial topography, worsening vision). If denied, North Carolina residents can

Getting Kuvan (Sapropterin) Covered by Humana in North Carolina: Complete Coding & Appeals Guide

Quick Answer: Your Path to Kuvan Coverage Kuvan (sapropterin) requires prior authorization from Humana, billed under Medicare Part D using NDC codes (not J-codes). Key steps: 1) Ensure correct ICD-10 coding (E70.0 for classical PKU, E70.1 for other hyperphenylalaninemia), 2) Submit weight-based dosing documentation with specialist confirmation, 3)

How to Get Lamzede (velmanase alfa-tycv) Covered by Cigna in North Carolina: Complete Appeals Guide with Forms and Deadlines

Answer Box: Getting Lamzede Covered by Cigna in North Carolina Lamzede (velmanase alfa-tycv) typically requires prior authorization from Cigna since it's not on most 2024 formularies. Here's your fastest path to approval: 1. Submit PA request through Cigna's provider portal with genetic testing confirming

How to Get Strensiq (asfotase alfa) Covered by Aetna CVS Health in North Carolina: Appeals Guide & Templates

Answer Box: Getting Strensiq Covered by Aetna CVS Health in North Carolina Aetna CVS Health covers Strensiq (asfotase alfa) for pediatric-onset hypophosphatasia with prior authorization. Key requirements: ALPL gene mutation OR low alkaline phosphatase plus elevated substrates, proof of onset before age 18, and specialist prescription. If denied, you have