Topic

North Carolina

A collection of 504 issues

UnitedHealthcare's Coverage Criteria for Adynovate in North Carolina: What Counts as "Medically Necessary"?

Answer Box: Getting Adynovate Covered by UnitedHealthcare in North Carolina Adynovate (bdanocog alfa pegol) requires prior authorization from UnitedHealthcare for hemophilia A treatment. To qualify, you need confirmed Factor VIII deficiency, bleeding history documentation, and hematologist prescription. First step today: Have your hematologist submit a prior authorization via the UHC

How to Get Skyrizi (Risankizumab) Covered by Humana in North Carolina: Decision Tree & Appeals Guide

Quick Answer: Humana Medicare Advantage requires prior authorization for Skyrizi (risankizumab) with documented TNF inhibitor failure for psoriasis, or CDAI scores for Crohn's disease. Submit via Humana provider portal with clinical notes showing severity (PASI ≥10, BSA ≥10%). If denied, you have 65 days to appeal internally, then

How to Get Xyrem (Sodium Oxybate) Covered by Cigna in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Xyrem Covered by Cigna in North Carolina To get Xyrem (sodium oxybate) covered by Cigna in North Carolina, you need: 1. REMS enrollment (prescriber and patient) through xywavxyremrems.com 2. Prior authorization with PSG/MSLT results and documented step therapy failure (dextroamphetamine or Wakix) 3. Prescription through

How to Get Voxzogo (vosoritide) Covered by Cigna in North Carolina: Complete PA Guide and Appeal Process

Quick Answer: Getting Voxzogo Covered by Cigna in North Carolina Cigna requires prior authorization for Voxzogo (vosoritide) with specific criteria: child under 18, genetically confirmed achondroplasia via FGFR3 testing, open growth plates, and prescription by pediatric endocrinologist or geneticist. If denied, North Carolina's Smart NC external review offers

How to Get Venclexta (Venetoclax) Covered by Cigna in North Carolina: Timeline, Forms & Appeals Guide

Answer Box: Getting Venclexta (Venetoclax) Covered by Cigna in North Carolina Cigna requires prior authorization (PA) for Venclexta (venetoclax), typically processed through Express Scripts/Accredo in 2-5 business days. Your fastest path: submit electronically via CoverMyMeds or EviCore with complete clinical documentation including TLS monitoring plan, baseline labs, and NCCN

How to Get Opsumit (Macitentan) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Opsumit Approved by Aetna CVS Health in North Carolina Opsumit (macitentan) requires prior authorization from Aetna CVS Health for pulmonary arterial hypertension (PAH) treatment. The fastest path: (1) Complete the Aetna Rx PA form with WHO Group 1 PAH diagnosis, step therapy documentation, and REMS enrollment, (2)

How to Get Upstaza (Kebilidi) Covered by Humana in North Carolina: Timeline, Appeals & Requirements Guide

Answer Box: Getting Upstaza (Kebilidi) Covered by Humana in North Carolina Upstaza (Kebilidi) approval by Humana requires genetic confirmation of AADC deficiency, treatment at a certified center, and prior authorization. Timeline: 1-5 days for initial review, up to 30 days for complex cases. First step today: Contact your neurologist to

How to Get Ozempic and Mounjaro Covered by Cigna in North Carolina: Complete Prior Authorization Timeline and Appeal Guide

Answer Box: Getting Ozempic/Mounjaro Covered by Cigna in North Carolina Cigna typically decides prior authorization requests for Ozempic (semaglutide) and Mounjaro (tirzepatide) within 72 hours for standard reviews or 24 hours for urgent cases. For Type 2 diabetes patients in North Carolina, the fastest path to approval requires: (1)

How to Get Vitrakvi (Larotrectinib) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Vitrakvi Coverage To get Vitrakvi (larotrectinib) covered by UnitedHealthcare in North Carolina: Submit prior authorization via OptumRx with validated NTRK gene fusion test results, oncologist medical necessity letter documenting metastatic/unresectable disease, and prior therapy history. If denied, file internal appeal within 180 days, then

How to Get Xospata (Gilteritinib) Covered by Cigna in North Carolina: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Xospata (Gilteritinib) Covered by Cigna in North Carolina Xospata requires prior authorization from Cigna for relapsed/refractory AML with confirmed FLT3 mutation. Your fastest path: 1) Verify FLT3 test results (ITD or TKD via FDA-approved assay), 2) Have your hematologist/oncologist submit PA via Cigna portal with