How to Get Brensocatib (BRINSUPRI) Covered by Humana in Florida: Complete Approval Guide
Answer Box: Quick Path to Approval
To get Brensocatib (BRINSUPRI) covered by Humana in Florida: Submit prior authorization with confirmed bronchiectasis diagnosis via chest CT, documented failure of macrolide antibiotics, and ≥2 pulmonary exacerbations requiring antibiotics in the past year. Your pulmonologist must complete Humana's coverage determination form with medical necessity letter. Standard review takes 72 hours; expedited decisions come within 24 hours if delay threatens health. If denied, you have 65 days to appeal. Start by calling Humana at 1-866-315-7587 to request the drug-specific form.
Table of Contents
- How to Use This Guide
- Eligibility Triage: Do You Qualify?
- If You're Likely Eligible: Document Checklist
- If You're Possibly Eligible: Tests to Request
- If You're Not Yet Eligible: Alternative Paths
- If Denied: Appeal Path Chooser
- Coverage Requirements at a Glance
- Common Denial Reasons & Fixes
- Costs & Patient Support Options
- FAQ
- Sources & Further Reading
How to Use This Guide
This guide helps Florida patients and their doctors navigate Humana's prior authorization process for Brensocatib (BRINSUPRI), the first FDA-approved treatment for non-cystic fibrosis bronchiectasis. Work through the eligibility triage first, then follow the specific path for your situation.
Brensocatib costs approximately $88,000 annually and requires strict utilization management. Humana typically requires step therapy with macrolide antibiotics before approval, making proper documentation of prior treatment failures essential.
Note: This information applies to Humana Medicare Advantage and Part D plans in Florida. Requirements may vary slightly for other Humana products.
Eligibility Triage: Do You Qualify?
Likely Eligible ✅
- Age 12 or older
- Confirmed non-cystic fibrosis bronchiectasis via chest CT scan
- ≥2 pulmonary exacerbations in past 12 months requiring systemic antibiotics (adults) OR ≥1 exacerbation (ages 12-17)
- Documented failure of or contraindication to macrolide antibiotics
- Negative cotinine test within 30 days (non-smoker)
- Prescribed by pulmonologist or infectious disease specialist
- No primary asthma or COPD diagnosis
Possibly Eligible ⚠️
- Bronchiectasis diagnosis but missing recent chest CT
- Frequent respiratory symptoms but exacerbations not well-documented
- Tried macrolides but outcomes not clearly recorded
- Recent smoker (quit within past month)
Not Yet Eligible ❌
- No confirmed bronchiectasis diagnosis
- Fewer than required exacerbations
- Haven't tried macrolide antibiotics
- Primary asthma or COPD diagnosis
- Current smoker
- Age under 12
If You're Likely Eligible: Document Checklist
Step 1: Gather Required Documentation
- High-resolution chest CT showing bronchiectasis pattern
- Pulmonary function tests
- Documentation of ≥2 exacerbations requiring antibiotics (include dates, symptoms, treatments)
- Records of macrolide antibiotic trials (azithromycin, clarithromycin) with outcomes
- Negative cotinine test within 30 days
- ICD-10 diagnosis code J47 (bronchiectasis)
Step 2: Submit Prior Authorization
Call Humana: 1-866-315-7587 to request Brensocatib-specific coverage determination form
Submission Options:
- Online: Complete form through Humana member portal
- Fax: 1-800-310-9071 with completed form and documentation
- Mail: CarePlus Health Plans, Attention: CarePlus Clinical Pharmacy Review, P.O. Box 14601, Lexington, KY 40512-4601
Timeline: 72 hours for standard review; 24 hours for expedited if delay threatens health
Step 3: Track Your Request
Monitor status through Humana's online portal or call member services. You'll receive written notification of the decision.
If You're Possibly Eligible: Tests to Request
Missing Documentation to Obtain:
- High-resolution chest CT if diagnosis needs confirmation
- Cotinine test if smoking status unclear
- Detailed exacerbation history from all treating physicians
- Macrolide trial documentation from previous providers
Timeline to Reapply:
- Gather missing documentation within 30 days
- Resubmit complete prior authorization request
- Consider expedited review if symptoms worsen
Tip: Request medical records from all previous pulmonologists and primary care doctors to document your complete treatment history.
If You're Not Yet Eligible: Alternative Paths
Standard Treatment Options to Try First:
- Macrolide antibiotics (azithromycin 250mg three times weekly)
- Airway clearance therapy (positive expiratory pressure devices)
- Inhaled antibiotics for frequent exacerbations
- Hypertonic saline with breathing techniques
Preparing for Future Exception Request:
- Document all treatment attempts with dates and outcomes
- Track exacerbation frequency and severity
- Maintain detailed symptom diary
- Ensure regular pulmonologist follow-up
When to Reapply:
After completing adequate trials of standard therapies (typically 3-6 months) or if you experience qualifying exacerbations.
If Denied: Appeal Path Chooser
First-Level Internal Appeal
Timeline: File within 65 days of denial notice Decision: 30 days (pre-service) or 60 days (post-service) How to Submit: Use Humana Appeal Form online, fax, or mail
Peer-to-Peer Review
When: Before or during appeal process How: Call number on denial notice to request medical director review Prepare: Have prescriber available to discuss clinical rationale
Expedited Appeal
When: Delay threatens life, health, or function Timeline: Decision within 72 hours Requirements: Provider must support urgency claim
External Review (Florida)
When: After exhausting internal appeals Timeline: 4 months to request after final denial How: Contact Florida Department of Financial Services at 1-877-MY-FL-CFO Cost: Free to consumer
From our advocates: We've seen success when patients include a detailed timeline showing how standard treatments failed and how continued exacerbations impact daily life. The key is connecting your specific medical history to Humana's coverage criteria with clear documentation.
Coverage Requirements at a Glance
| Requirement | What It Means | Where to Find It |
|---|---|---|
| Prior Authorization | Pre-approval required | Humana formulary |
| Step Therapy | Try macrolides first | Provider documentation |
| Specialist Prescriber | Pulmonologist/ID physician | NPI verification |
| Diagnosis Confirmation | Chest CT showing bronchiectasis | Radiology report |
| Exacerbation History | ≥2 requiring antibiotics/year | Medical records |
| Non-smoker Status | Negative cotinine test | Lab results |
| Age Requirement | ≥12 years old | Medical record |
Common Denial Reasons & Fixes
| Denial Reason | How to Overturn |
|---|---|
| "Not medically necessary" | Submit detailed medical necessity letter with ASPEN trial data and treatment guidelines |
| "Step therapy not completed" | Provide documentation of macrolide failures or contraindications |
| "Insufficient exacerbation history" | Request records from all providers showing antibiotic treatments for respiratory symptoms |
| "Primary asthma/COPD" | Submit pulmonary function tests and specialist notes differentiating bronchiectasis |
| "Smoking history" | Provide negative cotinine test and smoking cessation documentation |
Costs & Patient Support Options
Manufacturer Support
- Insmed Patient Support Program: Financial assistance and copay support
- Contact: Visit BRINSUPRI.com or call patient services
Additional Resources
- Medicare Extra Help: Low-income subsidy for Part D costs
- State Pharmaceutical Assistance Programs: Florida may offer additional support
- Patient advocacy organizations: Bronchiectasis and NTM Research Registry
Counterforce Health specializes in turning insurance denials into successful appeals by analyzing denial letters and crafting evidence-backed responses aligned to each plan's specific criteria. Their platform helps patients, clinicians, and pharmacies navigate complex prior authorization requirements and appeal processes.
FAQ
How long does Humana prior authorization take for Brensocatib in Florida? Standard review takes up to 72 hours; expedited review decisions come within 24 hours if delay threatens health.
What if Brensocatib is non-formulary on my Humana plan? Submit a formulary exception request using the same coverage determination process, with prescriber documentation that formulary alternatives are ineffective.
Can I request an expedited appeal if denied? Yes, if your prescriber confirms that delaying treatment would seriously jeopardize your life, health, or ability to regain maximum function.
Does step therapy apply if I failed macrolides with a previous insurer? Yes, but provide documented proof of prior failures from your previous providers to support your request.
What's the difference between Medicare Part C and Part D appeals for Brensocatib? Part C (Medicare Advantage medical benefits) has 30-60 day decision timelines; Part D (prescription drugs) has 7-day standard timelines.
Who can help if Humana denies my appeal? Contact the Florida Department of Financial Services at 1-877-MY-FL-CFO for external review assistance, or consider working with Counterforce Health for professional appeal support.
Sources & Further Reading
- Humana Medicare Drug Coverage and Appeals
- Florida Department of Financial Services Insurance Consumer Helpline
- CMS Medicare Part D Coverage Determination Process
- BRINSUPRI Prescribing Information
- Humana Prior Authorization Forms and Procedures
Disclaimer: This information is for educational purposes only and does not constitute medical or legal advice. Coverage decisions depend on individual circumstances and plan specifics. Always consult with your healthcare provider and insurance plan for personalized guidance. For additional help with Florida insurance appeals, contact the Florida Department of Financial Services Consumer Helpline at 1-877-MY-FL-CFO.
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