Topic

Ohio

A collection of 480 issues

How to Get Hemgenix Covered by UnitedHealthcare in Ohio: ICD-10, HCPCS Codes, and Appeal Guide

Answer Box: Getting Hemgenix Covered by UnitedHealthcare in Ohio Hemgenix (etranacogene dezaparvovec) requires prior authorization from UnitedHealthcare OptumRx for Ohio residents. Use ICD-10 code D67 (hereditary factor IX deficiency) and HCPCS code J1411 for billing. Submit PA requests through the UnitedHealthcare Provider Portal or call 888-397-8129. If denied, you have

How to Get Filsuvez (Birch Triterpenes) Covered by Humana in Ohio: Complete Requirements Checklist

Answer Box: Getting Filsuvez Covered by Humana in Ohio Filsuvez (birch triterpenes topical gel) requires prior authorization from Humana Medicare Advantage plans in Ohio. The fastest path to approval involves: (1) confirming your EB subtype diagnosis with genetic testing and ICD-10 code Q81.2 (dystrophic) or Q81.1/Q81.8

Blue Cross Blue Shield Ohio Coverage Criteria for Ocrevus: What Counts as "Medically Necessary"?

Answer Box: Getting Ocrevus Covered by Blue Cross Blue Shield in Ohio Blue Cross Blue Shield Ohio requires prior authorization for Ocrevus (ocrelizumab) with specific medical necessity criteria. To qualify: you must be 18+, have confirmed MS diagnosis via MRI, complete hepatitis B screening, and get approval through the NovoLogix

How to Get Nourianz (Istradefylline) Covered by Cigna in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: To get Nourianz (istradefylline) covered by Cigna in Ohio, you need prior authorization with documented Parkinson's disease, current carbidopa/levodopa use, and failed trials of amantadine, MAO-B inhibitors, and COMT inhibitors. Submit through your neurologist with OFF episode documentation. If denied, you have 180 days for

How to Get Pombiliti (cipaglucosidase alfa-atga) Covered by Aetna CVS Health in Ohio: Alternatives, Appeals & Authorization Guide

Answer Box: Getting Pombiliti Covered by Aetna CVS Health in Ohio Fastest Path: Aetna requires documented failure on Lumizyme or Nexviazyme before approving Pombiliti + Opfolda for late-onset Pompe disease. Start with formulary alternatives (Lumizyme/Nexviazyme) which have easier approval criteria. If those fail after 12+ months, document declining 6-minute walk

How to Get Keppra (Levetiracetam) Covered by Humana in Ohio: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Keppra (Levetiracetam) Covered by Humana in Ohio Generic levetiracetam is typically covered on lower formulary tiers by Humana Medicare plans in Ohio, while brand Keppra often requires prior authorization or formulary exceptions. Your fastest path: Check your specific plan's formulary at humana.com/pharmacy/medicare-drug-list,

Lowering Out-of-Pocket for Crysvita (burosumab) with Aetna (CVS Health) in Ohio: Copay Assistance, Tiering & Appeals

Quick Answer: Reducing Crysvita (burosumab) Costs with Aetna (CVS Health) in Ohio Crysvita costs $4,451-$13,354 per vial depending on dose. With Aetna (CVS Health), expect 50% coinsurance on this specialty-tier medication. Three key cost-reduction strategies: 1) Enroll in Kyowa Kirin Cares copay assistance (commercial insurance only), 2)

How to Get Orkambi (Lumacaftor/Ivacaftor) Covered by UnitedHealthcare in Ohio: Prior Authorization, Appeals, and Templates

Quick Answer: To get Orkambi (lumacaftor/ivacaftor) covered by UnitedHealthcare in Ohio, you need prior authorization with genetic testing confirming F508del homozygosity, CF specialist prescription, and documented clinical necessity. If denied, file internal appeals within 180 days, then request external review through Ohio Department of Insurance. Start by gathering your

Myths vs. Facts: Getting Busulfex (busulfan injection) Covered by UnitedHealthcare in Ohio

Answer Box: Getting Busulfex Covered by UnitedHealthcare in Ohio Fastest path to approval: Submit prior authorization through UnitedHealthcare's provider portal with complete conditioning regimen documentation, including CML diagnosis (ICD-10 C92.10), failed prior therapies, and transplant center pre-approval. If denied, file internal appeal within 180 days, then request

How to Get Tecentriq (Atezolizumab) Covered by Aetna in Ohio: Prior Authorization Forms, Appeals, and Timeline

Answer Box: Getting Tecentriq Covered by Aetna in Ohio Aetna requires prior authorization for Tecentriq (atezolizumab) in Ohio. The fastest path to approval involves submitting the complete Tecentriq Precertification Form with FDA-approved indication documentation, PD-L1 testing results (when required), and evidence of EGFR/ALK mutation status for lung cancer cases.