Topic

Pemazyre (pemigatinib)

A collection of 15 issues

Aetna (CVS Health)'s Coverage Criteria for Pemazyre (pemigatinib) in Virginia: What Counts as "Medically Necessary"?

Quick Answer: Getting Pemazyre (pemigatinib) Covered by Aetna (CVS Health) in Virginia Pemazyre requires prior authorization from Aetna (CVS Health) and is typically non-formulary, requiring a formulary exception. The fastest path to approval: (1) Submit complete documentation including positive FGFR2/FGFR1 molecular test results, prior therapy history, and baseline ophthalmologic
6 min read

Do You Qualify for Pemazyre (Pemigatinib) Coverage by Humana in Washington? Decision Tree & Next Steps

Answer Box: Your Path to Pemazyre Coverage Most patients with FGFR2 fusion-positive cholangiocarcinoma or FGFR1-rearranged myeloid/lymphoid neoplasms qualify for Pemazyre coverage by Humana in Washington. The fastest path: ensure you have documented FGFR testing results, complete baseline ophthalmologic exam, and submit prior authorization with these documents via your prescriber.
5 min read

How to Get Pemazyre (Pemigatinib) Covered by Aetna CVS Health in New York: Prior Authorization Guide and Appeals Process

Answer Box: Getting Pemazyre Covered by Aetna CVS Health in New York Pemazyre (pemigatinib) requires prior authorization with Aetna CVS Health plans and is often non-formulary, requiring a formulary exception. Success depends on three key elements: documented FGFR2/FGFR1 molecular testing results, comprehensive treatment history, and baseline ophthalmologic exam. First
5 min read

Get Pemazyre (Pemigatinib) Covered by Blue Cross Blue Shield in Washington: Prior Authorization Forms, Appeal Deadlines & Success Strategies

Answer Box: Getting Pemazyre Covered in Washington Pemazyre (pemigatinib) requires prior authorization from Blue Cross Blue Shield plans in Washington. Success depends on documenting FGFR2 fusion/rearrangement, prior therapy failure, and an ophthalmic monitoring plan. If denied, Washington's external review process through an Independent Review Organization (IRO) provides
5 min read

How to Get Pemazyre (Pemigatinib) Covered by Blue Cross Blue Shield in Ohio: Prior Authorization, Appeals & Step Therapy Override Guide

Answer Box: Getting Pemazyre Covered by BCBS Ohio Pemazyre (pemigatinib) is covered by Blue Cross Blue Shield Ohio but requires prior authorization with documented FGFR2 fusion/rearrangement testing and ophthalmology monitoring plan. Fastest path to approval: Submit PA with biomarker report, treatment history, and baseline eye exam documentation. Start today:
5 min read

Get Pemazyre (Pemigatinib) Covered by UnitedHealthcare in California: Prior Authorization Guide and Appeal Scripts

Answer Box: Fastest Path to Pemazyre Coverage To get Pemazyre (pemigatinib) covered by UnitedHealthcare in California: You need prior authorization with documented FGFR2 fusion/rearrangement via FDA-approved testing, previous treatment history, and unresectable/metastatic cholangiocarcinoma diagnosis. Submit through UnitedHealthcare provider portal with complete molecular testing results. If denied, file internal
5 min read

The Requirements Checklist to Get Pemazyre (Pemigatinib) Covered by UnitedHealthcare in Michigan: Forms, Appeals, and Approval Steps

Answer Box: Quick Path to Pemazyre Coverage Getting Pemazyre (pemigatinib) covered by UnitedHealthcare in Michigan requires prior authorization with specific clinical documentation. The fastest path: (1) Submit PA request through UHC Provider Portal with FGFR2 fusion test results and prior therapy records, (2) Include ophthalmology monitoring plan and drug interaction
6 min read