Topic

North Carolina

A collection of 430 issues

How to Get Epidiolex (Cannabidiol) Covered by Blue Cross Blue Shield in North Carolina: Forms, Appeals, and Formulary Alternatives

Answer Box: Getting Epidiolex Covered by Blue Cross Blue Shield in North Carolina Blue Cross Blue Shield of North Carolina covers Epidiolex (cannabidiol) as a specialty drug with prior authorization for FDA-approved seizure conditions (Lennox-Gastaut syndrome, Dravet syndrome, tuberous sclerosis complex). First step: Have your neurologist submit a PA request

How to Get Pomalyst (Pomalidomide) Covered by Cigna in North Carolina: Complete 2025 Guide with Forms and Appeal Scripts

Answer Box: Getting Pomalyst Covered by Cigna in North Carolina Cigna covers Pomalyst (pomalidomide) for multiple myeloma with prior authorization after at least one prior regimen including lenalidomide and/or a proteasome inhibitor. Medicare Advantage plans list it as Tier 4 specialty; commercial plans require PA and often step therapy.

How to Get Oxervate (Cenegermin) Covered by Cigna in North Carolina: Prior Authorization, Appeals, and Approval Guide

Answer Box: Quick Eligibility Check To get Oxervate (cenegermin) covered by Cigna in North Carolina, you need: (1) Stage 2 or 3 neurotrophic keratitis diagnosed by an ophthalmologist, (2) documented failure of preservative-free artificial tears for 4-6 weeks, and (3) prior authorization through Accredo specialty pharmacy. First step today: Have

The Requirements Checklist to Get Revlimid (lenalidomide) Covered by UnitedHealthcare in North Carolina

Answer Box: Getting Revlimid Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Revlimid (lenalidomide) in North Carolina, with specific criteria for multiple myeloma, MDS, and mantle cell lymphoma. The fastest path: verify REMS enrollment, submit PA via UHC provider portal with diagnosis-specific documentation, and use North Carolina&

Lowering Out-of-Pocket Costs for Ruconest with UnitedHealthcare in North Carolina: Copay Cards, Appeals & Financial Assistance

Answer Box: Getting Ruconest Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Ruconest (C1 esterase inhibitor [recombinant]) in North Carolina, with 12-month approvals for confirmed hereditary angioedema (HAE) patients prescribed by allergists/immunologists. The fastest path: 1) Have your HAE specialist submit PA via UHC Provider Portal

Lowering Out-of-Pocket Costs for Ilaris (Canakinumab) with UnitedHealthcare in North Carolina: Coverage, Appeals & Financial Assistance

Answer Box: Getting Ilaris Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Ilaris (canakinumab) under the medical benefit, with step therapy requirements for most indications. Start by having your specialist submit a PA request via the UHC provider portal with complete clinical documentation. If denied, appeal within

How to Get Givlaari (givosiran) Covered by Humana in North Carolina: Complete Appeals Guide with Templates

Answer Box: Getting Givlaari (givosiran) Covered by Humana in North Carolina Humana requires prior authorization for Givlaari (givosiran) for acute hepatic porphyria. To get approved: (1) Have your specialist document ≥2 attacks in the past 6 months plus elevated ALA/PBG levels, (2) Submit PA through Humana's provider

How to Get Gilenya (fingolimod) Covered by UnitedHealthcare in North Carolina: Prior Authorization Forms, Appeal Timelines, and External Review Rights

Answer Box: Getting Gilenya Covered in North Carolina UnitedHealthcare requires prior authorization for Gilenya (fingolimod) through OptumRx, typically requiring documentation of ≥2 failed MS therapies plus baseline safety tests (EKG, eye exam, labs). North Carolina provides 72-hour step therapy exception decisions and 120-day external review rights through Smart NC after

Aetna's Coverage Criteria for Hemlibra (emicizumab-kxwh) in North Carolina: What Counts as "Medically Necessary"?

Answer Box: Getting Hemlibra Approved by Aetna in North Carolina Aetna covers Hemlibra (emicizumab-kxwh) for hemophilia A prophylaxis when prescribed by a hematologist with documented FVIII deficiency and inhibitor status. Your fastest path: (1) Have your hematologist submit prior authorization via Aetna's provider portal with weight-based dosing, bleeding

Getting Revcovi (Elapegademase) Covered by Humana in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Revcovi (Elapegademase) Covered by Humana in North Carolina To get Revcovi (elapegademase) covered by Humana in North Carolina, you need: confirmed ADA-SCID diagnosis with genetic testing and enzyme levels <1%, specialist evaluation by pediatric immunologist, and documentation of medical necessity. Fastest path: Submit prior authorization through