Topic

North Carolina

A collection of 504 issues

How to Get Defitelio (defibrotide) Covered by Cigna in North Carolina: Complete PA Guide and Appeals Process

Answer Box: Getting Defitelio Covered by Cigna in North Carolina Defitelio (defibrotide) requires prior authorization from Cigna for hepatic veno-occlusive disease (VOD/SOS) with organ dysfunction post-stem cell transplant. Submit PA through electronic portals like CoverMyMeds or Evicore for fastest approval (often same-day). Include HSCT details, VOD/SOS diagnosis with

How to Get Kesimpta (ofatumumab) Covered by Humana in North Carolina: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Kesimpta Approved by Humana in North Carolina Kesimpta (ofatumumab) requires prior authorization from Humana Medicare Advantage plans in North Carolina, typically at Tier 5 specialty coverage. Your fastest path to approval: Have your neurologist submit a PA request with documentation of relapsing MS diagnosis, hepatitis B screening,

How to Get Mepsevii (vestronidase alfa-vjbk) Covered by Aetna (CVS Health) in North Carolina: Prior Authorization Guide and Appeals Process

Answer Box: Quick Path to Approval Aetna (CVS Health) requires prior authorization for Mepsevii (vestronidase alfa-vjbk) in North Carolina. To get approved: (1) Have a metabolic specialist confirm MPS VII diagnosis via enzyme assay and genetic testing, (2) Submit Aetna's Mepsevii precertification form with lab results and clinical

How to Get Advate (Octocog Alfa) Covered by Cigna in North Carolina: Complete Timeline & Appeals Guide

Answer Box: Getting Advate Covered by Cigna in North Carolina Cigna requires prior authorization for Advate (octocog alfa) in North Carolina, typically processed in 2-5 business days for complete electronic submissions. The fastest path: have your hemophilia specialist submit PA via CoverMyMeds with diagnosis, inhibitor testing, and bleed history. If

How to Get Brineura (Cerliponase Alfa) Covered by Cigna in North Carolina: Appeals, Prior Authorization, and Coverage Guide

Answer Box: Getting Brineura Covered by Cigna in North Carolina Brineura (cerliponase alfa) requires prior authorization from Cigna for CLN2 disease patients ≥3 years old. First step: Have your pediatric neurologist submit a PA request through Express Scripts/Accredo with CLN2 diagnosis confirmation, TPP1 enzyme testing, and medical necessity documentation.

Do You Qualify for Chenodal (Chenodiol) Coverage by Humana in North Carolina? Decision Tree & Next Steps

Answer Box: Quick Qualification Check Most likely to get approved: Patients with confirmed radiolucent gallstones in a functioning gallbladder who cannot undergo surgery, OR confirmed cerebrotendinous xanthomatosis (CTX) with genetic testing. Fastest path: Have your gastroenterologist or neurologist submit a prior authorization with imaging showing radiolucent stones (for gallstones) or

How to Get Ultomiris (ravulizumab) Approved by UnitedHealthcare in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Ultomiris Approved by UnitedHealthcare in North Carolina To get Ultomiris (ravulizumab) covered by UnitedHealthcare in North Carolina, you'll need prior authorization with documented medical necessity. Most plans require step therapy (trying eculizumab/Soliris first) unless you qualify for an exception. The fastest path: 1) Verify

How to Get Bavencio (avelumab) Covered by Humana in North Carolina: Prior Authorization Guide and Appeals Process

Answer Box: Getting Bavencio (avelumab) Covered by Humana in North Carolina Bavencio (avelumab) requires prior authorization from Humana but is covered for FDA-approved indications (metastatic Merkel cell carcinoma and certain urothelial carcinoma cases). Fastest path to approval: Submit complete PA with diagnosis, staging, performance status, and treatment history. First step

How to Get Abecma (idecabtagene vicleucel) Covered by Blue Cross Blue Shield of North Carolina: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Abecma Covered by Blue Cross Blue Shield of North Carolina Abecma (idecabtagene vicleucel) requires prior authorization from Blue Cross Blue Shield of North Carolina for adults with relapsed/refractory multiple myeloma after ≥2 prior therapies. Your fastest path to approval: (1) Verify you have a state-regulated BCBS

Myths vs. Facts: Getting Gamifant (emapalumab-lzsg) Covered by Humana in North Carolina

Answer Box: Getting Gamifant Covered by Humana in North Carolina Humana Medicare Advantage plans typically require medical prior authorization for Gamifant (emapalumab-lzsg) for primary HLH. Success depends on documented conventional therapy failure and meeting HLH-2004 criteria. First step: Have your hematologist submit a PA request via Humana's provider