Topic

North Carolina

A collection of 251 issues

Oxbryta (Voxelotor) Coverage by UnitedHealthcare in North Carolina: Understanding the 2024 FDA Withdrawal and Your Options

Answer Box Oxbryta (voxelotor) is no longer covered by UnitedHealthcare or any insurer because Pfizer voluntarily withdrew it from all markets in September 2024 following FDA safety concerns. All claims for Oxbryta are now universally denied due to loss of FDA approval. If you're currently taking Oxbryta, contact

How to Get Palynziq (pegvaliase-pqpz) Covered by Cigna in North Carolina: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Palynziq Covered by Cigna in North Carolina Eligibility: Adults with PKU and blood phenylalanine >600 µmol/L despite standard therapy qualify for Palynziq coverage through Cigna's prior authorization process. Fastest path: Have your PKU specialist submit PA documentation including REMS enrollment, baseline labs, and

How to Get Procysbi (Cysteamine Bitartrate DR) Covered by Blue Cross Blue Shield in North Carolina: Complete PA Guide with Appeals Timeline

Answer Box: Getting Procysbi Covered by BCBS North Carolina Procysbi (cysteamine bitartrate DR) requires prior authorization from Blue Cross Blue Shield of North Carolina, with step therapy requirements typically mandating a trial of immediate-release cysteamine first. Your fastest path to approval: 1. Gather documentation: Confirmed nephropathic cystinosis diagnosis (ICD-10: E72.

Myths vs. Facts: Getting Increlex (Mecasermin) Covered by Cigna in North Carolina

Answer Box: Getting Increlex (Mecasermin) Covered by Cigna in North Carolina Cigna requires prior authorization for Increlex (mecasermin) with strict criteria: severe primary IGF-1 deficiency, height ≤-3.0 SDS, normal/elevated growth hormone, and pediatric endocrinologist involvement. If denied, you have 180 days for internal appeals, then can request external

Do You Qualify for Hetlioz (Tasimelteon) Coverage by Cigna in North Carolina? Decision Tree & Next Steps

Answer Box: Qualifying for Hetlioz (Tasimelteon) Coverage You likely qualify for Cigna coverage of Hetlioz (tasimelteon) in North Carolina if you have: * Confirmed Non-24-Hour Sleep-Wake Disorder or Smith-Magenis Syndrome diagnosis * Sleep specialist evaluation with 14+ days of sleep logs/actigraphy * Documentation of failed alternative treatments (if step therapy applies) Fastest

Getting Elzonris (Tagraxofusp-erzs) Covered by Humana in North Carolina: Complete Coding, Prior Authorization & Appeals Guide

Answer Box: Get Elzonris Covered by Humana in 3 Steps Elzonris (tagraxofusp-erzs) requires prior authorization from Humana Medicare Advantage plans in North Carolina. Fastest path to approval: 1) Gather BPDCN pathology with CD123-positive immunophenotype and baseline albumin ≥3.2 g/dL, 2) Submit PA request via Humana provider portal using

How to Get Zolgensma Covered by Blue Cross Blue Shield in North Carolina: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Zolgensma Covered in North Carolina Fastest path to approval: Submit Blue Cross Blue Shield's prior authorization with genetic confirmation (bi-allelic SMN1 mutation), AAV9 antibody titers ≤1:50, and complete steroid protocol plan. If denied, file internal appeal within plan deadlines, then request external review through

How Long Does It Take to Get Gattex (Teduglutide) Approved by Cigna in North Carolina? Complete Timeline Guide

Quick Answer: Cigna typically processes Gattex (teduglutide) prior authorization requests within 2 business days for standard cases, 24 hours for urgent situations. In North Carolina, if denied, you have 180 days for internal appeals and 120 days for Smart NC external review. Start by having your gastroenterologist submit complete parenteral

Myths vs. Facts: Getting Tremfya (Guselkumab) Covered by Humana in North Carolina

Answer Box: Getting Tremfya Covered by Humana in North Carolina Eligibility: Moderate-to-severe plaque psoriasis with PASI ≥10 or equivalent severity, failed conventional systemic therapy (methotrexate, cyclosporine), and negative TB screening within 12 months. Fastest path: Work with a dermatologist to submit prior authorization with complete documentation: diagnosis severity scores, prior

How to Get Pombiliti (cipaglucosidase alfa-atga) Covered by Aetna CVS Health in North Carolina: Timeline, Appeals & Documentation Guide

Answer Box: Getting Pombiliti Covered by Aetna CVS Health in North Carolina Pombiliti (cipaglucosidase alfa-atga) requires prior authorization from Aetna CVS Health with strict documentation requirements. The fastest path to approval: (1) Confirm diagnosis of late-onset Pompe disease with enzyme/genetic testing, (2) Document inadequate response to prior ERT therapy,