Topic

North Carolina

A collection of 504 issues

Work With Your Doctor to Get Acthar Gel Covered by Cigna in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box Getting Acthar Gel (repository corticotropin injection) covered by Cigna in North Carolina requires prior authorization approval before dispensing through Express Scripts' Accredo specialty pharmacy. Your fastest path: (1) Verify your diagnosis meets Cigna's approved conditions (infantile spasms, MS exacerbations, rheumatologic disorders), (2) Document corticosteroid failure/

Lowering Out-of-Pocket Costs for Enhertu with UnitedHealthcare in North Carolina: Copay Cards, Tiering Appeals, and Financial Assistance

Answer Box: Enhertu (fam-trastuzumab deruxtecan-nxki) costs $150,000+ annually but UnitedHealthcare commercial patients can reduce out-of-pocket to $0 drug cost plus $100/infusion using the ENHERTU4U copay program. Submit prior authorization via UnitedHealthcare Provider Portal with HER2-positive pathology results and prior therapy documentation. If denied, appeal internally within 180 days,

How Long Does It Take to Get Advate (octocog alfa) Approved by Blue Cross Blue Shield in North Carolina? Timeline & Milestones

Answer Box: Getting Advate Approved in North Carolina Blue Cross Blue Shield of North Carolina (BCBSNC) processes Advate (octocog alfa) prior authorization requests within 72 hours for standard reviews and 24 hours for urgent cases. The fastest path to approval requires complete documentation including factor VIII levels, inhibitor screening, bleeding

Myths vs. Facts: Getting Mepsevii (vestronidase alfa-vjbk) Covered by Humana in North Carolina

Answer Box: Getting Mepsevii (vestronidase alfa-vjbk) Covered by Humana in North Carolina Myth-busting reality: Humana Medicare Advantage plans require prior authorization for Mepsevii, but approval is achievable with proper documentation. You need confirmed MPS VII diagnosis, specialist involvement, and FDA-label dosing (4 mg/kg every 2 weeks). If denied, North

How to Get Filsuvez Covered by Cigna in North Carolina: Prior Authorization Forms, Appeal Scripts & External Review Guide

Answer Box: Fast-Track to Filsuvez Coverage Cigna requires prior authorization for Filsuvez (birch triterpenes topical gel) via Express Scripts/Accredo for epidermolysis bullosa patients ≥6 months with confirmed dystrophic or junctional subtypes. Submit through Cigna provider portal or CoverMyMeds with genetic testing, wound photos (10-50 cm², 21 days-9 months old)

How to Get Kesimpta (ofatumumab) Covered by Aetna (CVS Health) in North Carolina: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Kesimpta (ofatumumab) Covered by Aetna (CVS Health) in North Carolina Kesimpta (ofatumumab) requires prior authorization from Aetna (CVS Health) for relapsing multiple sclerosis. Submit via CVS Caremark PA portal with neurologist letter documenting relapsing MS diagnosis (ICD-10: G35), prior DMT failures, and HBV screening. Standard decisions take

How to Get Photrexa (Riboflavin) Covered by Cigna in North Carolina: Complete PA Guide and Appeals Timeline

Answer Box: Fastest Path to Approval Cigna covers FDA-approved epi-off corneal cross-linking with Photrexa riboflavin for progressive keratoconus when prior authorization criteria are met. Your ophthalmologist must document progression (≥1.0 D Kmax increase over 12-24 months) and corneal thickness ≥400 µm. Submit PA through Cigna provider portal with serial

How to Get Kymriah (tisagenlecleucel) Covered by Aetna (CVS Health) in North Carolina: Complete Guide to Prior Authorization, Appeals, and Coding

Answer Box: Fast Track to Kymriah Coverage Aetna (CVS Health) requires prior authorization for Kymriah (tisagenlecleucel) in North Carolina. Your fastest path: (1) Confirm CD19-positive pathology and treatment at an Aetna-contracted CAR-T center, (2) Submit PA with complete treatment history via 1-877-212-8811, and (3) Request expedited review (≤72 hours) if

How to Get Tracleer (Bosentan) Covered by Blue Cross Blue Shield in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Tracleer (Bosentan) Covered in North Carolina Tracleer (bosentan) requires prior authorization from Blue Cross Blue Shield of North Carolina (BCBSNC) for WHO Group 1 pulmonary arterial hypertension. Key requirements: REMS program enrollment, specialist prescriber (cardiologist/pulmonologist), baseline liver tests, and trial of generic bosentan first. If denied,

How to Get Kymriah (Tisagenlecleucel) Covered by UnitedHealthcare in North Carolina: Prior Authorization Guide with Appeal Templates

Answer Box: Quick Path to Kymriah Coverage To get Kymriah (tisagenlecleucel) covered by UnitedHealthcare in North Carolina: Your oncologist must submit prior authorization through the UHCprovider.com portal with CD19 positivity confirmation, documented prior therapy failures, and certified treatment center verification. If denied, you have 60 days to appeal internally,