Topic

North Carolina

A collection of 430 issues

How to Get Cresemba (isavuconazole) Covered by Humana in North Carolina: Prior Authorization Guide and Appeal Process

Answer Box: Getting Cresemba Covered by Humana in North Carolina Cresemba (isavuconazole) requires prior authorization from Humana and is typically placed on Tier 4 (Specialty) with higher cost-sharing. To get approval: 1) Confirm your diagnosis of invasive aspergillosis or mucormycosis with culture/biopsy results, 2) Submit Humana's coverage

Myths vs. Facts: Getting Aldurazyme (laronidase) Covered by UnitedHealthcare in North Carolina

Answer Box: Getting Aldurazyme Covered by UnitedHealthcare in North Carolina Eligibility: UnitedHealthcare requires prior authorization for Aldurazyme (laronidase) with confirmed MPS I diagnosis through enzymatic testing and genetic confirmation. Fastest path: Have your MPS specialist submit complete PA documentation including IDUA enzyme deficiency results, genetic testing, and baseline clinical assessments.

Myths vs. Facts: Getting Opsumit (Macitentan) Covered by Humana in North Carolina

Answer Box: Humana Medicare Advantage members in North Carolina cannot use Smart NC external review and must follow federal Medicare appeals. Commercial Humana plan members may qualify for Smart NC's free external review process. For Opsumit (macitentan), expect prior authorization requiring WHO Group 1 PAH diagnosis, specialist prescriber,

How to Get Kesimpta (Ofatumumab) Covered by Cigna in North Carolina: Complete PA Guide with Appeals Process

Answer Box: Getting Kesimpta Covered by Cigna in North Carolina Fastest path to approval: Verify Kesimpta requires prior authorization through your Cigna plan, have your neurologist submit the Multiple Sclerosis CCRD Prior Authorization Form via CoverMyMeds or Surescripts ePA, and designate Accredo Specialty Pharmacy for dispensing. If denied, file internal

Coding That Helps Get Rebif (Interferon Beta-1a) Approved by Aetna CVS Health in North Carolina: ICD-10, HCPCS, and NDC Guide

Answer Box: Getting Rebif Approved in North Carolina Rebif (interferon beta-1a) requires prior authorization from Aetna CVS Health in North Carolina. The fastest approval path: (1) Use correct ICD-10 code G35.A for relapsing-remitting MS with documented disease activity, (2) Submit complete prior authorization through CVS Specialty with step therapy

Renewing Soliris (Eculizumab) Coverage with Blue Cross Blue Shield in North Carolina: Complete Timeline and Documentation Guide

Answer Box: Soliris (eculizumab) requires annual reauthorization with Blue Cross Blue Shield of North Carolina. Start renewal 30-60 days before expiration by gathering updated labs (LDH, hemoglobin, platelets), clinical response documentation, and current vaccination records. Submit through Blue e or your specialty pharmacy. If denied, use Smart NC external review—

Get Brineura (Cerliponase Alfa) Covered by Aetna (CVS Health) in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Brineura Covered by Aetna in North Carolina Fastest path to approval: Have a CLN2-specialized neurologist submit prior authorization through Aetna's provider portal with documented motor function scores ≥1 on the CLN2 Clinical Rating Scale, confirmed TPP1 deficiency, and an approved intraventricular administration site. Authorization typically

How to Get Carbaglu (Carglumic Acid) Covered by Humana in North Carolina: Prior Authorization Guide with Appeal Process

Answer Box: Getting Carbaglu Approved by Humana in North Carolina Humana requires prior authorization (PA) for Carbaglu (carglumic acid) in North Carolina due to its specialty status and high cost. Most approvals take 72 hours for standard review or 24 hours for expedited cases when medical urgency is documented. The

How to Get Ferriprox (deferiprone) Covered by Humana in North Carolina: Appeals Guide with Forms and Timelines

Answer Box: Getting Ferriprox (deferiprone) Covered by Humana in North Carolina Ferriprox (deferiprone) is typically covered by Humana Medicare Advantage plans in North Carolina with prior authorization and Tier 5 specialty cost-sharing. Most denials stem from missing step therapy documentation or inadequate medical necessity evidence. Fastest path to approval: 1)

The Requirements Checklist to Get Ferriprox (deferiprone) Covered by Blue Cross Blue Shield in North Carolina

Answer Box: Getting Ferriprox Covered by Blue Cross Blue Shield in North Carolina Who qualifies: Patients with transfusional iron overload from thalassemia, sickle cell disease, or other anemias who need deferiprone (Ferriprox) therapy. Fastest path to approval: 1) Verify your Blue Cross NC plan type and formulary status, 2) Submit