Topic

Opsumit (macitentan)

A collection of 13 issues

Renewing Opsumit (Macitentan) Approval with UnitedHealthcare in North Carolina: 2025 Requirements & Timeline

Answer Box: Opsumit (macitentan) renewal with UnitedHealthcare in North Carolina requires submitting updated clinical documentation 30-60 days before your current authorization expires. Key 2025 changes: OptumRx is eliminating many chronic disease reauthorizations, but Opsumit's status must be verified through your provider portal. If still required, submit WHO functional

How to Get Opsumit (Macitentan) Covered by Aetna CVS Health in New Jersey: Complete Prior Authorization and Appeals Guide

Quick Answer: Opsumit (macitentan) requires prior authorization from Aetna CVS Health in New Jersey. Submit your PA request online via the Availity portal with complete PAH documentation, specialist notes, and prior therapy records. If denied, you can appeal internally (60 days) then request external review through New Jersey's

Renewing Opsumit (Macitentan) Approval with Humana in Ohio: Complete Guide to Timelines, Documentation, and Appeals

Answer Box: Renewing Opsumit Coverage with Humana in Ohio To renew Opsumit (macitentan) approval with Humana in Ohio: Submit renewal requests 2-4 weeks before your current authorization expires using Humana's electronic portal or CoverMyMeds. Include updated clinical documentation showing continued benefit, stable/improved functional class, and recent lab

Do You Qualify for Opsumit (Macitentan) Coverage by UnitedHealthcare in Florida? Decision Tree & Next Steps

Quick Answer: Opsumit Coverage by UnitedHealthcare in Florida Most likely eligible if: You have confirmed WHO Group 1 PAH, functional class II-IV symptoms, and a PAH specialist prescriber. Fastest approval path: Have your specialist submit prior authorization through UnitedHealthcare's provider portal with complete hemodynamic data and functional class

How to Get Opsumit (Macitentan) Covered by Aetna CVS Health in Pennsylvania: 2025 Forms, Appeals & Contact Guide

Quick Answer: Opsumit (macitentan) requires prior authorization from Aetna CVS Health in Pennsylvania. Submit the 2024 PA form via fax (1-888-267-3277) or electronic portal with PAH diagnosis documentation, specialist consultation, and step therapy records. If denied, use Pennsylvania's new external review program—50% of appeals succeed. Start with

Coding That Helps Get Opsumit (macitentan) Approved in New York with Blue Cross Blue Shield (ICD-10, HCPCS/J-Code, NDC)

Answer Box: Getting Opsumit Approved with Blue Cross Blue Shield in New York Fastest path to approval: Use ICD-10 code I27.0 (primary PAH) or I27.21 (secondary PAH), document NYHA functional class II-III, and ensure pregnancy testing compliance per current FDA labeling (REMS discontinued April 2025). Submit via electronic

Myths vs. Facts: Getting Opsumit (macitentan) Covered by Aetna (CVS Health) in Ohio

Answer Box: Getting Opsumit (macitentan) Covered by Aetna (CVS Health) in Ohio Eligibility: Aetna requires prior authorization for all Opsumit requests with WHO Group 1 PAH diagnosis and specialist prescription. Fastest Path: Submit PA through Aetna provider portal with right heart catheterization results, WHO functional class II-III documentation, and pregnancy

How to Get Opsumit (Macitentan) Covered by Humana in Florida: Appeals Guide with Forms and Timelines

Answer Box: Getting Opsumit (Macitentan) Covered by Humana in Florida Fastest Path to Approval: Submit a prior authorization request with complete PAH documentation including right heart catheterization results, WHO functional class, and REMS pregnancy testing compliance. If denied, file an appeal within 65 days using Humana's online portal

Getting Opsumit (Macitentan) Covered by Aetna CVS Health in Texas: Complete Prior Authorization Guide

Answer Box: Fast Track to Opsumit Approval To get Opsumit (macitentan) covered by Aetna CVS Health in Texas: Your prescriber must submit prior authorization demonstrating WHO Group 1 PAH diagnosis, specialist involvement (pulmonologist/cardiologist), and REMS enrollment with monthly pregnancy testing documentation. If denied, Texas law gives you 180 days

How Long Does It Take to Get Opsumit (Macitentan) Approved by Blue Cross Blue Shield in California? Complete Timeline Guide

Answer Box: Opsumit Approval Timeline in California Getting Opsumit (macitentan) approved by Blue Cross Blue Shield of California typically takes 5-30 days, depending on your benefit type and documentation completeness. For PAH patients, the fastest path involves: (1) having your pulmonologist submit prior authorization with complete WHO functional class documentation,