Topic

North Carolina

A collection of 54 issues

How to Get Lamzede (velmanase alfa-tycv) Covered by Aetna in North Carolina: PA Requirements, Appeals, and Smart NC External Review

Quick Answer: Getting Lamzede Covered by Aetna in North Carolina Aetna requires prior authorization for Lamzede (velmanase alfa-tycv) in 2024. To get coverage, you need: confirmed alpha-mannosidosis diagnosis (enzyme deficiency or MAN2B1 genetic testing), specialist prescriber, and clinical documentation. If denied, North Carolina's Smart NC program offers external

How to Get Xywav (Ca/Mg/K/Na Oxybates) Covered by Aetna CVS Health in North Carolina: Complete Guide to Prior Authorization, Appeals, and External Review

Quick Answer: Xywav requires prior authorization from Aetna CVS Health in North Carolina. You'll likely need to try modafinil or armodafinil first (step therapy), then your doctor must submit clinical documentation proving medical necessity. If denied, you can appeal internally twice, then request external review through North Carolina&

Get Soliris (Eculizumab) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization Guide

Answer Box: Fastest Path to Soliris Coverage Getting Soliris (eculizumab) covered by Aetna CVS Health in North Carolina requires meeting strict diagnostic criteria and completing mandatory vaccinations. Step 1: Confirm your diagnosis with required lab tests (flow cytometry for PNH, anti-AChR antibodies for myasthenia gravis). Step 2: Complete meningococcal vaccination

Myths vs. Facts: Getting Opfolda (miglustat) Covered by Aetna (CVS Health) in North Carolina

Answer Box: Getting Opfolda Covered by Aetna in North Carolina Opfolda (miglustat) requires prior authorization from Aetna (CVS Health) when used with Pombiliti for late-onset Pompe disease (LOPD). The fastest path to approval: 1) Submit precertification via Availity portal with complete LOPD diagnosis documentation and ERT failure history, 2) Include