Topic

Ohio

A collection of 480 issues

How to Get Tepezza (Teprotumumab) Covered by Aetna CVS Health in Ohio: Complete Prior Authorization Guide

Quick Answer: Getting Tepezza Covered by Aetna CVS Health in Ohio Fastest path to approval: Aetna CVS Health requires prior authorization for Tepezza (teprotumumab) in Ohio. You need moderate-to-severe thyroid eye disease documentation, euthyroid status, and specialist involvement. Submit the PA form with complete clinical records through your provider. If

How to Get Entresto (Sacubitril/Valsartan) Covered by Humana in Ohio: ICD-10 Codes, Prior Authorization, and Appeals Guide

Answer Box: Getting Entresto (Sacubitril/Valsartan) Covered by Humana in Ohio Entresto requires prior authorization from Humana in Ohio. Submit requests through CoverMyMeds or fax to 888-447-3430. Use ICD-10 code I50.22 (chronic systolic heart failure) with documented LVEF <40-50%. Include evidence of ACE inhibitor/ARB intolerance or failure.

How to Get Uptravi (Selexipag) Covered by UnitedHealthcare in Ohio: Complete Guide with Forms, Appeals & Contact Info

Answer Box: Getting Uptravi Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Uptravi (selexipag) in Ohio through OptumRx. The fastest path to approval: (1) Submit PA request via the UnitedHealthcare Provider Portal with complete PAH documentation, (2) Include WHO Group I PAH diagnosis, functional class, and prior therapy

Myths vs. Facts: Getting Juxtapid (lomitapide) Covered by Humana in Ohio

Answer Box: Getting Juxtapid Covered by Humana in Ohio Myth-busting fact: Your doctor's prescription alone won't guarantee Humana coverage for Juxtapid (lomitapide) in Ohio. Reality: You need prior authorization with specific documentation including HoFH diagnosis confirmation, failed trials of statins/ezetimibe/PCSK9 inhibitors, and REMS program

Renewing Rapivab (Peramivir) Approval with Blue Cross Blue Shield in Ohio: Annual Requirements, Timeline & Appeals

Answer Box: Renewing Rapivab Coverage in Ohio Blue Cross Blue Shield Ohio requires annual prior authorization renewal for Rapivab (peramivir), typically 30-60 days before your current approval expires. Key steps: 1) Have your provider submit renewal documentation showing ongoing medical necessity, 2) Include updated clinical notes and reasons oral antivirals

Get Ruconest (C1 Esterase Inhibitor) Covered by Aetna CVS Health in Ohio: Complete 2024 Guide with Forms and Appeal Scripts

Answer Box: Getting Ruconest Covered by Aetna CVS Health in Ohio You'll likely qualify for Ruconest coverage if you have confirmed C1-INH deficiency HAE with documented attacks and a specialist prescriber. The fastest path: 1) Confirm your diagnosis meets Aetna's lab criteria (low C4 and C1-INH

Renewing Abecma (Idecabtagene Vicleucel) Approval with Cigna in Ohio: Complete Timeline and Documentation Guide

Answer Box: Renewing Abecma Approval with Cigna in Ohio Quick Answer: Cigna now provides 6-month authorization windows for Abecma (idecabtagene vicleucel) as of January 2025, requiring renewal documentation 4-6 weeks before expiration. Submit through CoverMyMeds or ExpressPAth with updated medical necessity letter, treatment response data, and current pathology reports. If

Denied for Synagis (Palivizumab) by UnitedHealthcare in Ohio? Complete Appeals Guide (Templates & Timelines)

Answer Box: Getting Synagis Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Synagis (palivizumab) with strict eligibility criteria: premature infants ≤35 weeks gestation and <6 months old, or children <24 months with chronic lung disease/congenital heart disease. If denied, you have 180 days to appeal

How to Get Dojolvi (Triheptanoin) Covered by Blue Cross Blue Shield in Ohio: Complete PA Guide with Appeal Scripts

Answer Box: Getting Dojolvi Covered by Blue Cross Blue Shield in Ohio You can get Dojolvi (triheptanoin) covered by Blue Cross Blue Shield Ohio, but it requires molecular confirmation of LC-FAOD and specialist oversight. Start by gathering genetic test results proving your long-chain fatty acid oxidation disorder diagnosis, then have

Get Uplizna (Inebilizumab) Covered by Cigna in Ohio: Decision Tree & Appeals Guide

Answer Box: Your Path to Uplizna Coverage in Ohio To get Uplizna (inebilizumab) covered by Cigna in Ohio: First, confirm your diagnosis (AQP4-positive NMOSD or IgG4-related disease) and complete required lab screening (HBV, TB). Your specialist must submit a prior authorization through Express Scripts ePA portal or by calling 1-800-882-4462.