Topic

Orkambi (lumacaftor/ivacaftor)

A collection of 17 issues

How to Get Orkambi Covered by Blue Cross Blue Shield in Ohio: Prior Authorization, Appeals, and Approval Timeline

Answer Box: Getting Orkambi Covered by BCBS Ohio Blue Cross Blue Shield (Anthem) Ohio requires prior authorization for Orkambi (lumacaftor/ivacaftor) with strict documentation of cystic fibrosis and F508del homozygosity (two copies of the mutation). The fastest path to approval: 1. Confirm genetic eligibility: Get genetic test results showing F508del

Getting Orkambi (Lumacaftor/Ivacaftor) Covered by Blue Cross Blue Shield in California: Complete Guide to Prior Authorization and Appeals

Answer Box: Quick Path to Orkambi Coverage in California Orkambi (lumacaftor/ivacaftor) requires prior authorization from Blue Cross Blue Shield of California for patients with cystic fibrosis who are F508del homozygous. Success requires three key elements: genetic testing documentation, specialist prescription, and proper ICD-10 coding (E84.0-E84.9). If denied,

How to Get Orkambi (lumacaftor/ivacaftor) Covered by UnitedHealthcare in New York: Complete Guide to Forms, Appeals, and Approval

Answer Box: Getting Orkambi Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Orkambi (lumacaftor/ivacaftor) in New York, with specific criteria: confirmed CF diagnosis, homozygous F508del mutation, age ≥1 year, and specialist involvement. Start today by gathering genetic testing results and having your CF specialist submit the

How to Get Orkambi Covered by UnitedHealthcare in New Jersey: Appeals Guide, Forms & Timelines

Answer Box: Getting Orkambi Covered in New Jersey UnitedHealthcare requires prior authorization for Orkambi (lumacaftor/ivacaftor) in cystic fibrosis patients who are homozygous for the F508del mutation and age 1 or older. The fastest path to approval involves submitting genetic test results, CF specialist documentation, and clinical notes through OptumRx.

How to Get Orkambi (lumacaftor/ivacaftor) Covered by Cigna in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Orkambi (lumacaftor/ivacaftor) Covered by Cigna in Georgia Eligibility: Patients ≥1 year old with cystic fibrosis and confirmed F508del homozygous mutation. Fastest path: Submit prior authorization with genetic test results showing F508del/F508del genotype, CF diagnosis documentation, and specialist prescription. First step today: Contact your CF specialist

How to Get Orkambi Covered by Humana in Virginia: Medical Necessity Requirements and Appeals Process

Answer Box: Getting Orkambi Covered by Humana in Virginia Eligibility: Orkambi requires Humana prior authorization for patients aged 1+ with cystic fibrosis and confirmed F508del/F508del genotype. Fastest path: Have your CF specialist submit genetic testing results, current pulmonary function tests, and medical necessity letter via Humana's provider

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

How to Get Orkambi (lumacaftor/ivacaftor) Covered by Aetna CVS Health in Ohio: Coding, Appeals, and Prior Authorization Guide

Answer Box: Getting Orkambi Covered by Aetna CVS Health in Ohio Orkambi (lumacaftor/ivacaftor) requires prior authorization from Aetna CVS Health for cystic fibrosis patients who are homozygous for the F508del mutation. The fastest path to approval: (1) Confirm genetic testing shows F508del homozygous status, (2) Have a pulmonologist submit

How to Get Orkambi Covered by Cigna in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Orkambi Covered by Cigna in Florida Orkambi (lumacaftor/ivacaftor) requires prior authorization from Cigna, with approval typically taking 5 business days. To get covered in Florida: (1) Your CF specialist submits genetic documentation proving F508del homozygosity, (2) Cigna reviews clinical criteria including age ≥1 year and CF

The Complete Requirements Checklist to Get Orkambi (lumacaftor/ivacaftor) Covered by Humana in Pennsylvania

Answer Box: Getting Orkambi Covered by Humana in Pennsylvania Orkambi (lumacaftor/ivacaftor) requires prior authorization from Humana in Pennsylvania. Your fastest path to approval: 1) Confirm F508del homozygous cystic fibrosis diagnosis with genetic testing, 2) Have your CF specialist submit Humana's prior authorization form with complete medical necessity