Topic

North Carolina

A collection of 251 issues

How to Get Acthar Gel Covered by Aetna CVS Health in North Carolina: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Acthar Gel Covered by Aetna CVS Health in North Carolina Acthar Gel requires prior authorization from Aetna CVS Health for all indications. For North Carolina residents, the fastest path to approval involves: (1) Submit a complete PA request with detailed clinical documentation proving corticosteroid failure or contraindications,

How to Get Onpattro (Patisiran) Covered by Cigna in North Carolina: Complete Timeline, Forms & Appeal Guide

Answer Box: Getting Onpattro (Patisiran) Covered by Cigna in North Carolina Eligibility: Adults with hereditary transthyretin amyloidosis polyneuropathy (hATTR-PN) confirmed by genetic testing and neurologist evaluation. Fastest Path: Submit complete prior authorization through Cigna's provider portal with genetic test results, neurologist consultation notes, and mNIS+7 scores. Standard

How to Get Filsuvez (Birch Triterpenes Gel) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Filsuvez Covered by UnitedHealthcare in North Carolina Filsuvez requires prior authorization from UnitedHealthcare/OptumRx for epidermolysis bullosa wound care. To get approval in North Carolina: 1) Gather genetic testing confirming dystrophic or junctional EB, wound documentation, and specialist evaluation, 2) Submit PA request via UnitedHealthcare provider portal

How to Get Evkeeza (Evinacumab) Covered by Cigna in North Carolina: Complete Prior Authorization Guide

Answer Box: Quick Path to Evkeeza Coverage Evkeeza (evinacumab) requires prior authorization from Cigna in North Carolina. To get approved, you need: (1) confirmed homozygous familial hypercholesterolemia diagnosis with genetic testing or clinical criteria, (2) documentation of maximally tolerated statin, ezetimibe, and PCSK9 inhibitor trials (if age ≥10), and (3)

Getting Strimvelis Gene Therapy Covered by Blue Cross Blue Shield in North Carolina: Complete Guide to International Coverage and Appeals

Answer Box: Getting Strimvelis Covered by Blue Cross Blue Shield in North Carolina Strimvelis gene therapy for ADA-SCID is not FDA-approved in the U.S. and requires treatment at San Raffaele Hospital in Milan, Italy. Blue Cross Blue Shield of North Carolina (Blue Cross NC) does not have a specific

How to Get Soliris (Eculizumab) Covered by Humana in North Carolina: Complete Prior Authorization Guide with Appeals Process

Answer Box: Getting Soliris Covered by Humana in North Carolina Humana requires strict prior authorization for Soliris (eculizumab) with specific documentation for FDA-approved conditions. The fastest path: (1) Confirm your diagnosis meets FDA criteria (PNH, aHUS, gMG, or NMOSD) with required labs, (2) Submit complete documentation through CenterWell Specialty Pharmacy

How to Get Ocrevus (Ocrelizumab) Covered by Cigna in North Carolina: Appeals Guide & Forms

Answer Box: Getting Ocrevus Covered by Cigna in North Carolina Fastest path to approval: Submit prior authorization through your neurologist with documented MS diagnosis, prior DMT failure/intolerance, and hepatitis B screening. If denied, file internal appeal within 180 days, then external review through North Carolina's Smart NC

How to Get Takhzyro (lanadelumab-flyo) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Takhzyro Coverage To get Takhzyro (lanadelumab-flyo) covered by Aetna CVS Health in North Carolina: Submit prior authorization with confirmed HAE diagnosis (C1-INH/C4 labs), documented attack history, and specialist prescription. If denied, file internal appeal within 180 days, then external review through Smart NC within

Lowering Out-of-Pocket for Eloctate with Cigna in North Carolina: Copay Cards, Appeals, and Financial Aid

Answer Box: Getting Eloctate Covered by Cigna in North Carolina Eloctate requires prior authorization from Cigna and is typically placed on a non-preferred specialty tier with high copays. Fast-track approval: Have your hematologist submit PA documentation including hemophilia A diagnosis, Factor VIII levels, bleeding history, and clinical justification. Apply for

How to Get Xospata (Gilteritinib) Covered by Aetna CVS Health in North Carolina: Forms, Appeals, and Alternative Paths

Quick Answer: To get Xospata (gilteritinib) covered by Aetna CVS Health in North Carolina, you'll need prior authorization with FLT3 mutation testing, documentation of relapsed/refractory AML, and evidence of medical necessity. If denied, you have 180 days to appeal internally, then can request external review through North