Topic

Orkambi (lumacaftor/ivacaftor)

A collection of 25 issues

How to Get Orkambi (lumacaftor/ivacaftor) Covered by Blue Cross Blue Shield in Virginia: PA Forms, Appeal Scripts & State Protections

Answer Box: Getting Orkambi Covered by Blue Cross Blue Shield in Virginia Blue Cross Blue Shield (Anthem) in Virginia requires prior authorization for Orkambi (lumacaftor/ivacaftor) with genetic testing proving F508del mutations and age ≥2 years. Virginia's step therapy laws protect CF patients with documented contraindications or prior

How to Get Orkambi (lumacaftor/ivacaftor) Covered by UnitedHealthcare in Washington: Prior Authorization, Appeals, and Coding Guide

Answer Box: Getting Orkambi Covered in Washington UnitedHealthcare requires prior authorization for Orkambi (lumacaftor/ivacaftor) based on confirmed cystic fibrosis diagnosis, homozygous F508del CFTR mutation documentation, and prescription by a CF specialist. Submit through OptumRx with genetic lab results, ICD-10 E84.0-E84.9, and clinical notes. If denied, Washington residents

Work With Your Doctor to Get Orkambi (lumacaftor/ivacaftor) Covered by Cigna in Virginia: Complete Guide

Answer Box: Getting Orkambi Covered by Cigna in Virginia To get Orkambi (lumacaftor/ivacaftor) approved by Cigna in Virginia, you need: F508del homozygous genotype confirmation, a CF specialist prescription, and prior authorization documentation. The fastest path: (1) Schedule a CF center visit to gather genetic testing and clinical documentation, (2)

Myths vs. Facts: Getting Orkambi (lumacaftor/ivacaftor) Covered by Blue Cross Blue Shield in New Jersey

Answer Box: Getting Orkambi covered by Blue Cross Blue Shield in New Jersey requires prior authorization with documented F508del homozygous mutation, CF specialist prescription, and baseline clinical data. If denied, you have internal appeal rights plus New Jersey's Independent Health Care Appeals Program (IHCAP) through Maximus Federal within

Do You Qualify for Orkambi Coverage by Cigna in Illinois? Complete Decision Tree and Appeals Guide

Answer Box: Getting Orkambi Covered by Cigna in Illinois Orkambi requires prior authorization from Cigna and F508del homozygous genetic confirmation. In Illinois, you have strong appeal rights through the state's external review process if denied. First step today: Ensure your CF specialist has your genetic test results showing

How to Get Orkambi (lumacaftor/ivacaftor) Covered by Humana in Georgia: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Getting Orkambi Covered by Humana in Georgia Orkambi requires prior authorization from Humana with documented F508del homozygosity and specialist evaluation. If denied, you have 65 days to file an internal appeal and can request external review through the Georgia Department of Insurance within 60 days of final denial.

Getting Orkambi (lumacaftor/ivacaftor) Covered by Cigna in North Carolina: Complete Guide to Prior Authorization, Appeals, and Templates

Quick Answer: Getting Orkambi Covered by Cigna in North Carolina Cigna requires prior authorization for Orkambi (lumacaftor/ivacaftor) with proof of homozygous F508del mutation and CF specialist prescription. If denied, you have 180 days for internal appeals, then can request external review through North Carolina's Smart NC program.

Getting Orkambi (lumacaftor/ivacaftor) Covered by Cigna in New Jersey: Complete Guide to Prior Authorization, Appeals, and Templates

Answer Box: Quick Path to Coverage Cigna requires prior authorization for Orkambi (lumacaftor/ivacaftor) in New Jersey. You'll need genetic testing showing F508del homozygosity, a CF specialist prescription, and documented medical necessity. If denied, you have 180 days to appeal internally, then can request New Jersey's

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,