Topic

Xyrem (sodium oxybate)

A collection of 23 issues

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.

How to Get Xyrem (Sodium Oxybate) Covered by UnitedHealthcare in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Xyrem Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization and step therapy for Xyrem (sodium oxybate) in New York. The fastest path to approval: (1) Complete REMS enrollment for both prescriber and patient at XywavXyremREMS.com, (2) Document failed trials of modafinil or armodafinil, and

Get Xyrem (Sodium Oxybate) Covered by UnitedHealthcare in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Xyrem Covered by UnitedHealthcare in Michigan To get Xyrem (sodium oxybate) covered by UnitedHealthcare in Michigan, you'll need prior authorization through OptumRx. First, ensure REMS enrollment is complete at XywavXyremREMS.com. Then submit a prior authorization request with sleep study results, documented narcolepsy diagnosis, and

How to Get Xyrem (Sodium Oxybate) Covered by Aetna CVS Health in Ohio: Complete Timeline & Appeal Guide

Answer Box: Getting Xyrem Covered by Aetna CVS Health in Ohio Xyrem (sodium oxybate) requires prior authorization from Aetna CVS Health and REMS program enrollment before coverage. The fastest path to approval: 1. Complete REMS enrollment for both patient and prescriber at xywavxyremrems.com 2. Submit prior authorization with narcolepsy

Do You Qualify for Xyrem (Sodium Oxybate) Coverage by Humana in Georgia? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Xyrem Coverage Yes, Xyrem can be covered by Humana in Georgia, but requires prior authorization. The fastest path: (1) Confirm your narcolepsy diagnosis meets clinical criteria with documented sleep studies, (2) Submit Humana's Medicare Part D PA form with medical necessity letter

Do You Qualify for Xyrem Coverage by UnitedHealthcare in Pennsylvania? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Xyrem Coverage To get Xyrem (sodium oxybate) covered by UnitedHealthcare in Pennsylvania: You need a confirmed narcolepsy diagnosis with documented cataplexy, REMS program enrollment, and prior authorization showing you've tried and failed preferred alternatives like modafinil or stimulants. Start today: Have your

Myths vs. Facts: Getting Xyrem (Sodium Oxybate) Covered by UnitedHealthcare in Florida - Complete 2025 Guide

Answer Box: Getting Xyrem Covered by UnitedHealthcare in Florida Eligibility: Patients with narcolepsy (with/without cataplexy) or excessive daytime sleepiness who meet strict clinical criteria and complete mandatory REMS enrollment. Fastest approval path: 1) Ensure both prescriber and patient are REMS-enrolled, 2) Submit complete prior authorization with sleep study results