Topic

Ohio

A collection of 479 issues

How to Get Strimvelis Gene Therapy Covered by Blue Cross Blue Shield in Ohio: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Strimvelis Covered in Ohio Strimvelis (ADA-SCID gene therapy) requires prior authorization from Blue Cross Blue Shield in Ohio, with appeals following a structured timeline: internal review (30 days), second-level appeal if needed, then external review through Ohio's Independent Review Organization (180-day deadline from final denial)
7 min read

How to Get Ultomiris (Ravulizumab) Covered by Cigna in Ohio: Prior Authorization, Appeals, and Alternative Options

Quick Answer: Getting Ultomiris Covered by Cigna in Ohio Cigna requires prior authorization for Ultomiris (ravulizumab) through Express Scripts/Accredo specialty pharmacy. Your hematologist or neurologist must submit medical necessity documentation showing diagnosis confirmation (ICD-10 codes), prior therapy failures, and vaccination requirements. If denied, Ohio residents have 180 days for
6 min read

Work With Your Doctor to Get Daybue (trofinetide) Covered by Blue Cross Blue Shield in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Daybue (trofinetide) covered by Blue Cross Blue Shield in Ohio requires prior authorization with confirmed Rett syndrome diagnosis (MECP2 genetic testing), patient age ≥2 years, and specialist prescriber attestation. If denied, you have 65 days for internal appeal followed by Ohio's external review process through
7 min read

How to Get Xospata (Gilteritinib) Covered by Humana in Ohio: Prior Authorization Forms, Appeal Timelines & Success Scripts

Quick Answer: Getting Xospata Covered by Humana in Ohio Humana requires prior authorization for Xospata (gilteritinib) with comprehensive clinical documentation. The fastest path to approval: (1) Verify your hematologist is in-network, (2) Submit FLT3 mutation test results with prior therapy history, and (3) Include a detailed medical necessity letter citing
6 min read

How to Get Spinraza (Nusinersen) Covered by Cigna in Ohio: Prior Authorization Guide, Appeals Process, and State Protections

Answer Box: Getting Spinraza Covered by Cigna in Ohio Cigna requires prior authorization for Spinraza (nusinersen) with genetic testing documentation and specialist consultation. Ohio provides strong consumer protections including 180-day internal appeal windows and independent external review through the Ohio Department of Insurance. Fastest path to approval: 1. Ensure genetic
6 min read

How to Get Tepezza (Teprotumumab) Covered by UnitedHealthcare in Ohio: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Tepezza Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Tepezza (teprotumumab) in Ohio, with coverage limited to 8 lifetime infusions for moderate-to-severe thyroid eye disease. You'll need a Clinical Activity Score (CAS) ≥3, euthyroid thyroid labs, and documented steroid failure or contraindication. Submit
7 min read