Topic

Xyrem (sodium oxybate)

A collection of 29 issues

How to Get Xyrem (Sodium Oxybate) Covered by Cigna in Illinois: Prior Authorization Guide and Appeals Process

Answer Box: Getting Xyrem Covered by Cigna in Illinois Fastest path to approval: Cigna requires prior authorization for Xyrem (sodium oxybate) with documented narcolepsy diagnosis, sleep study results, and failed trials of first-line treatments. Submit the Cigna Xyrem PA form with complete clinical documentation. If denied, you have 180 days

How Long Does It Take to Get Xyrem (Sodium Oxybate) Approved by UnitedHealthcare in North Carolina? Complete Timeline & Appeals Guide

Quick Answer: Xyrem Approval Timeline in North Carolina Getting Xyrem (sodium oxybate) approved by UnitedHealthcare in North Carolina typically takes 1-15 business days for the prior authorization decision, plus 1-3 days for REMS enrollment. The fastest path: ensure both you and your prescriber complete REMS enrollment first, then have your

How to Get Xyrem (Sodium Oxybate) Covered by Cigna in Georgia: Complete Coding and Appeals Guide

Answer Box: Getting Xyrem Covered by Cigna in Georgia To get Xyrem (sodium oxybate) covered by Cigna in Georgia, you need proper diagnosis codes (G47.411 for narcolepsy with cataplexy), HCPCS J-code J8499, and enrollment in the Xyrem REMS program. Submit prior authorization through Cigna's provider portal or

How to Get Xyrem (Sodium Oxybate) Covered by Blue Cross Blue Shield in Pennsylvania: Complete 2024 Guide with Forms and Appeals

Answer Box: Getting Xyrem Covered by Blue Cross Blue Shield in Pennsylvania Xyrem requires prior authorization from all Blue Cross Blue Shield plans in Pennsylvania. The fastest path to approval: (1) Ensure both patient and prescriber are enrolled in the REMS program, (2) Submit PA through your plan's

How to Get Xyrem (Sodium Oxybate) Covered by Aetna (CVS Health) in California: Complete 2025 Guide

Quick Answer: Getting Xyrem Covered by Aetna (CVS Health) in California Yes, Aetna covers Xyrem with prior authorization. You'll need REMS enrollment first, then submit PA with sleep study results and documented stimulant/modafinil failures. Standard approval takes 15 business days. If denied, California's Independent Medical

How Long Does It Take to Get Xyrem Approved by UnitedHealthcare in Illinois? Complete Timeline & Approval Milestones

Answer Box: Xyrem Approval Timeline with UnitedHealthcare in Illinois Getting Xyrem (sodium oxybate) approved by UnitedHealthcare in Illinois typically takes 72 hours to 15 days, depending on documentation completeness and clinical urgency. Both patient and prescriber must complete REMS enrollment first (1-3 business days). UnitedHealthcare requires prior authorization with evidence

How to Get Xyrem (Sodium Oxybate) Covered by Cigna in Michigan: Complete Decision Tree & Appeals Guide 2025

Answer Box: Getting Xyrem Covered by Cigna in Michigan Quick path to approval: Cigna requires prior authorization for Xyrem (sodium oxybate) in Michigan, plus mandatory REMS enrollment for both prescriber and patient. Three key steps: 1) Confirm narcolepsy diagnosis with sleep studies (PSG + MSLT), 2) Document failed first-line therapy (stimulants/

Renewing Xyrem (Sodium Oxybate) Approval with Humana in North Carolina: 2025 Requirements and Timeline

Quick Answer: Xyrem Renewal with Humana in North Carolina Start your Xyrem renewal 30-45 days before expiration. Humana requires updated clinical documentation, evidence of continued medical necessity, and REMS program compliance. If denied, you have 65 days to appeal through Medicare's federal process (not North Carolina's

Myths vs. Facts: Getting Xyrem (Sodium Oxybate) Covered by UnitedHealthcare in California - Complete 2024 Guide

Quick Answer: Getting Xyrem Covered by UnitedHealthcare in California Yes, UnitedHealthcare covers Xyrem (sodium oxybate) in California with prior authorization. You'll need confirmed narcolepsy diagnosis, sleep study results, failed trials of stimulants/modafinil, and REMS enrollment. If denied, California's Independent Medical Review (IMR) offers strong appeal

How to Get Xyrem (Sodium Oxybate) Covered by Humana in New York: Complete Guide to Alternatives, Appeals & Approvals

Answer Box: Quick Path to Xyrem Coverage If Xyrem isn't initially approved by Humana in New York, you have three main options: try covered alternatives first (step therapy), request a formulary exception with medical necessity documentation, or appeal any denial through New York's external review process.