Topic

Ohio

A collection of 479 issues

Work With Your Doctor to Get Synagis (Palivizumab) Approved by Aetna CVS Health in Ohio: Complete Provider Collaboration Guide

Answer Box: Getting Synagis Approved in Ohio Aetna CVS Health requires prior authorization for Synagis (palivizumab) via their precertification form, approving only high-risk infants when Beyfortus is contraindicated or unavailable. Your pediatrician must document specific criteria (prematurity <29 weeks GA, chronic lung disease, or hemodynamically significant heart disease) and

Myths vs. Facts: Getting Oxbryta (voxelotor) Covered by Aetna (CVS Health) in Ohio After FDA Withdrawal

Answer Box: Oxbryta (voxelotor) Coverage Status Oxbryta (voxelotor) is no longer available in the United States. Pfizer voluntarily withdrew the medication globally on September 25-26, 2024, following FDA safety concerns about increased vaso-occlusive crises and deaths. Claims are now automatically denied due to loss of FDA approval. Fastest path to

How to Get Palynziq (pegvaliase-pqpz) Covered by Humana in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Palynziq Covered by Humana in Ohio Humana requires prior authorization for Palynziq (pegvaliase-pqpz) in Ohio, with coverage typically needing confirmed PKU diagnosis, blood phenylalanine >600 µmol/L despite diet optimization, failed sapropterin trial, age ≥18, and REMS enrollment. Submit PA through Humana provider portal with complete

How to Get Vitrakvi (Larotrectinib) Covered by Blue Cross Blue Shield in Ohio: Timeline, Appeals, and NTRK Testing Requirements

Quick Answer: Getting Vitrakvi Covered in Ohio Blue Cross Blue Shield in Ohio typically requires prior authorization for Vitrakvi (larotrectinib), with 15 business days for standard review or 72 hours for expedited cases. Success depends on complete NTRK fusion testing documentation, proof of metastatic/unresectable disease, and evidence of failed

How to Get Dupixent (dupilumab) Covered by Blue Cross Blue Shield in Ohio: Prior Authorization, Appeals, and Step Therapy Override Guide

Answer Box: Getting Dupixent Covered in Ohio Blue Cross Blue Shield (primarily Anthem) in Ohio requires prior authorization for Dupixent (dupilumab) with step therapy requirements varying by indication. Ohio's step therapy override law (ORC §3901.832) requires approval within 72 hours if you've failed preferred treatments

Work With Your Doctor to Get Translarna (Ataluren) Approved by Humana in Ohio: Complete Prior Authorization Guide

Answer Box: Getting Translarna (Ataluren) Covered by Humana in Ohio Translarna requires prior authorization from Humana across all plan types and is typically non-formulary, requiring a formulary exception with clinical justification. Your doctor must document: (1) genetic testing confirming nonsense mutation DMD, (2) current ambulatory status, and (3) corticosteroid trial

How to Get Lutathera (Lutetium Lu-177 Dotatate) Covered by Cigna in Ohio: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Lutathera Covered by Cigna in Ohio Yes, Cigna covers Lutathera (lutetium Lu-177 dotatate) for somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors, but prior authorization is required. Your fastest path to approval: 1) Have your oncologist submit a PA request with SSTR-positive imaging (Ga-68 DOTATATE PET/CT), pathology confirming well-differentiated

How to Get Turalio (Pexidartinib) Covered by UnitedHealthcare in Ohio: Complete PA and Appeals Guide

Answer Box: Getting Turalio Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Turalio (pexidartinib) with TGCT diagnosis confirmation, REMS enrollment, and surgical non-feasibility documentation. The fastest path: (1) Complete TURALIO REMS enrollment at turaliorems.com (3-5 days), (2) Gather pathology, imaging, and surgical consult notes, (3) Submit PA

How to Get Joenja (leniolisib) Covered by Blue Cross Blue Shield in Ohio: Complete PA Guide and Appeal Scripts

Answer Box: Getting Joenja (leniolisib) Covered by Blue Cross Blue Shield in Ohio Joenja (leniolisib) requires prior authorization from Blue Cross Blue Shield plans in Ohio. The fastest path to approval: (1) Confirm genetic testing proves APDS (PIK3CD or PIK3R1 variants), (2) Have your immunologist submit PA via Anthem'

The Requirements Checklist to Get Elevidys (delandistrogene moxeparvovec-rokl) Covered by Aetna (CVS Health) in Ohio

Answer Box: Fast Track to Elevidys Coverage Who qualifies: Ohio patients with confirmed DMD (excluding exon 8/9 deletions), age 4+, ambulatory status, and anti-AAVrh74 antibody titer <1:400. Fastest approval path: Submit complete prior authorization through CVS Specialty with genetic testing, specialist attestation, and Center of Excellence confirmation.