Topic

North Carolina

A collection of 504 issues

How to Get Natpara (Parathyroid Hormone) Covered by Cigna in North Carolina: Complete 2025 Appeals Guide

Answer Box Getting Natpara (parathyroid hormone) covered by Cigna in North Carolina requires understanding that Takeda discontinued manufacturing in December 2024. New starts are typically denied due to lack of commercial supply. For existing patients, you'll need prior authorization showing chronic hypoparathyroidism, failed conventional therapy (calcium + active vitamin

Work With Your Doctor to Get Revcovi (Elapegademase) Approved by Cigna in North Carolina: Complete Provider Partnership Guide

Answer Box: Your Path to Cigna Approval in North Carolina To get Revcovi (elapegademase) covered by Cigna in North Carolina for ADA-SCID, you need confirmed diagnosis documentation (genetic testing + ADA enzyme levels), specialist management by an immunologist, and a complete prior authorization showing failed/ineligible alternatives like bone marrow transplant.

How to Get Increlex (mecasermin) Covered by Aetna CVS Health in North Carolina: Requirements, Appeals, and Timeline

Answer Box: Getting Increlex Covered by Aetna CVS Health in North Carolina Aetna CVS Health requires prior authorization for Increlex (mecasermin) in children ages 2-18 with severe primary IGF-1 deficiency. Key requirements: height ≤3 SD below normal, IGF-1 ≤3 SD below normal (confirmed twice), normal GH stimulation test (≥10 ng/

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

Answer Box: Fast Track to Pemazyre (pemigatinib) Approval Getting Pemazyre (pemigatinib) covered by Aetna (CVS Health) in North Carolina requires prior authorization with FGFR testing documentation, prior therapy failure records, and medical necessity letters. Most denials stem from missing biomarker reports or inadequate step therapy documentation. First step: Gather FGFR2

How to Get Dojolvi (triheptanoin) Covered by Humana in North Carolina: Complete PA Guide and Appeal Process

Answer Box: Getting Dojolvi Covered by Humana in North Carolina Eligibility: You need molecular genetic confirmation of long-chain fatty acid oxidation disorder (LC-FAOD) and must discontinue all MCT products before starting Dojolvi. Fastest path: Submit prior authorization via Humana's provider portal with genetic testing results, specialist letter, and

How to Get Thiola / Thiola EC (Tiopronin) Covered by Blue Cross Blue Shield in North Carolina: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Thiola Covered by Blue Cross Blue Shield in North Carolina Blue Cross Blue Shield of North Carolina (BCBSNC) places Thiola and Thiola EC in Tier 5 (highest cost-sharing) with prior authorization required. To get approval: (1) Your doctor submits a PA request through the Prime Therapeutics portal

How to Get Raxone (idebenone) Covered by Cigna in North Carolina: Complete PA Guide with Forms and Appeal Templates

Answer Box: Getting Raxone (idebenone) Covered by Cigna in North Carolina Raxone (idebenone) requires a formulary exception from Cigna since it's not FDA-approved in the US. Start today: Have your physician call Cigna at 1-800-753-2851 to request a non-formulary exception with LHON genetic testing and specialist documentation. If

How to Get Voydeya (Danicopan) Covered by Humana in North Carolina: Prior Authorization Forms, Appeals Timeline, and State Protections

Answer Box: Your Path to Voydeya Coverage Getting Voydeya (danicopan) covered by Humana in North Carolina requires prior authorization with specific PNH documentation. Submit via Humana's provider portal or CoverMyMeds with flow cytometry confirming PNH diagnosis, evidence of extravascular hemolysis despite C5 inhibitor therapy, and completed vaccination records.

How to Get Poteligeo (mogamulizumab-kpkc) Covered by Cigna in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Poteligeo Covered by Cigna in North Carolina Cigna requires prior authorization for Poteligeo (mogamulizumab-kpkc) via Express Scripts/Accredo specialty pharmacy. Your oncologist or dermatologist must submit a PA request with confirmed mycosis fungoides/Sézary syndrome diagnosis, complete TNMB staging, and documentation of ≥1 failed prior systemic therapy.

Getting Pyrukynd (Mitapivat) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Pyrukynd Covered by UnitedHealthcare in North Carolina UnitedHealthcare covers Pyrukynd (mitapivat) on specialty formulary tiers for adults with genetically confirmed pyruvate kinase deficiency, requiring prior authorization through OptumRx. Key requirements: ≥2 PKLR gene variants (≥1 missense), baseline hemoglobin ≤10 g/dL, and hematologist prescription. If denied, North