Topic

Ultomiris (ravulizumab)

A collection of 30 issues

Myths vs. Facts: Getting Ultomiris (ravulizumab) Covered by Blue Cross Blue Shield in Ohio - Appeals Process and Requirements

Answer Box: Getting Ultomiris Covered by BCBS in Ohio Fastest Path to Approval: Blue Cross Blue Shield in Ohio requires prior authorization for Ultomiris (ravulizumab) with new step therapy requirements effective July 2024—patients must try Empaveli (pegcetacoplan) first unless contraindicated. Submit PA requests through NovoLogix online tool with complete
5 min read

Myths vs. Facts: Getting Ultomiris (Ravulizumab) Covered by UnitedHealthcare in Washington

Answer Box: Getting Ultomiris Covered by UnitedHealthcare in Washington Eligibility: UnitedHealthcare requires prior authorization for Ultomiris (ravulizumab) with step therapy—typically trying eculizumab first. Fastest path: Submit complete PA documentation including diagnosis confirmation (PNH flow cytometry, AChR+ for gMG, AQP4+ for NMOSD), vaccination records, and prior therapy failures. First step
5 min read

How to Get Ultomiris (ravulizumab) Covered by Humana in Ohio: Appeals Process and Medical Necessity Requirements

Answer Box: Getting Ultomiris (ravulizumab) Covered by Humana in Ohio Eligibility: Humana covers Ultomiris with prior authorization for FDA-approved conditions (PNH, aHUS, generalized myasthenia gravis, NMOSD). Fastest approval path: Call Humana Clinical Pharmacy Review at 800-555-CLIN (2546) with complete diagnostic labs, vaccination records, and medical necessity documentation. First step today:
5 min read

How to Get Ultomiris (ravulizumab) Covered by UnitedHealthcare in Pennsylvania: Complete Guide to Prior Authorization, Appeals & Forms

Quick Answer: Getting Ultomiris Covered by UnitedHealthcare in Pennsylvania To get Ultomiris (ravulizumab) covered by UnitedHealthcare in Pennsylvania, you'll need prior authorization through OptumRx. The fastest path: 1) Have your doctor submit a PA request via the UnitedHealthcare provider portal with complete clinical documentation, 2) Include proof of
6 min read

If Ultomiris (Ravulizumab) Isn't Approved by UnitedHealthcare in Michigan: Formulary Alternatives & Exception Strategies

Quick Answer: Your Options When Ultomiris Is Denied If UnitedHealthcare denies Ultomiris (ravulizumab) in Michigan, you have three main paths: try a formulary alternative like Soliris (eculizumab), request a formulary exception with medical necessity documentation, or pursue a formal appeal. Your fastest option is often requesting a peer-to-peer review where
6 min read

Renewing Ultomiris (Ravulizumab) Coverage with UnitedHealthcare in Texas: Annual Reapproval Guide and Timeline

Answer Box: Renewing Ultomiris Coverage with UnitedHealthcare in Texas UnitedHealthcare requires annual prior authorization renewal for Ultomiris (ravulizumab) with updated clinical documentation proving continued medical necessity. Start the renewal process 60-90 days before your current approval expires. Submit through the UnitedHealthcare Provider Portal with current lab results, treatment response data,
6 min read