Topic

North Carolina

A collection of 430 issues

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

Answer Box: Getting Givlaari (givosiran) covered by Aetna (CVS Health) in North Carolina requires prior authorization with specific documentation: elevated ALA/PBG levels during attacks, attack history requiring hospitalization or hemin, and specialist prescriber. Submit via CVS Caremark Specialty or Availity portal. If denied, North Carolina's Smart NC

Renewing Sumavel DosePro (Sumatriptan Injection, Needle-Free) Approval with Blue Cross Blue Shield in North Carolina: Annual Requirements & Timeline

Answer Box: Renewing Your Sumavel DosePro Authorization Blue Cross Blue Shield of North Carolina typically requires annual prior authorization renewal for Sumavel DosePro (sumatriptan injection, needle-free). Start the renewal process 60-90 days before your current approval expires to avoid coverage gaps. You'll need updated clinical documentation showing continued

How to Get Kymriah (tisagenlecleucel) Covered by Blue Cross Blue Shield of North Carolina: Complete Guide with Forms, Deadlines & Appeal Scripts

Answer Box: Getting Kymriah Covered by Blue Cross NC Blue Cross Blue Shield of North Carolina requires prior authorization for Kymriah (tisagenlecleucel) CAR-T therapy. Your fastest path: Submit via Availity portal with CD19-positive pathology, prior therapy documentation, and treatment at a certified CAR-T center. Appeals success rate is high when

How to Get Ocrevus Covered by UnitedHealthcare in North Carolina: PA Forms, Appeals, and Approval Timeline

Answer Box: Getting Ocrevus Covered by UnitedHealthcare in North Carolina UnitedHealthcare covers Ocrevus (ocrelizumab) in North Carolina when prior authorization criteria are met: confirmed MS diagnosis (relapsing forms or primary progressive), documented treatment history, and clinical necessity. No universal step therapy requirement exists in UHC's national policy, but

Myths vs. Facts: Getting Eloctate (Coagulation Factor VIII) Covered by Humana in North Carolina - Appeals Guide

Quick Answer: Getting Eloctate Covered by Humana in North Carolina Fastest path to approval: Have your hematologist submit prior authorization through Humana's provider portal with comprehensive bleeding logs, prior factor VIII failures, and medical necessity documentation. If denied, file internal appeal within 65 days, then request Smart NC

Getting Strimvelis Gene Therapy Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Strimvelis Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Strimvelis (autologous CD34+ ADA-SCID gene therapy) as a non-formulary, international specialty treatment. Start by confirming your ADA-SCID diagnosis with genetic testing, documenting failed or contraindicated alternatives, and submitting through the UHC Provider Portal. If denied,

Denied for Stelara by Blue Cross Blue Shield in North Carolina? Complete Appeals Guide (Forms, Timelines & Scripts)

Answer Box: Getting Stelara Covered by Blue Cross Blue Shield in North Carolina Blue Cross Blue Shield of North Carolina requires prior authorization for Stelara (ustekinumab), typically with step therapy requirements. If denied, you have strong appeal rights through North Carolina's Smart NC program. Fastest path: Submit a

How to Get Opfolda (miglustat) Covered by Blue Cross Blue Shield North Carolina: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Opfolda Covered by Blue Cross Blue Shield NC Opfolda (miglustat) requires prior authorization from Blue Cross Blue Shield North Carolina and must be used with Pombiliti for adult LOPD patients ≥40 kg who haven't improved on standard ERT for ≥1 year. First step today: Call

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

Answer Box: Getting Pyrukynd (mitapivat) Covered by Aetna (CVS Health) in North Carolina Pyrukynd (mitapivat) is non-formulary on Aetna plans and requires prior authorization with strict genetic and clinical criteria. You'll need confirmed pyruvate kinase deficiency (≥2 PKLR variants with ≥1 missense), hemoglobin ≤10 g/dL or significant

How to Get Procysbi (Cysteamine Bitartrate DR) Covered by Cigna in North Carolina: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Procysbi Covered by Cigna in North Carolina Cigna typically requires prior authorization for Procysbi (cysteamine bitartrate DR), often with step therapy requiring immediate-release cysteamine first. The fastest path: have your specialist submit a complete PA packet including nephropathic cystinosis diagnosis (ICD-10 E72.04), WBC cystine monitoring plan,