By Counterforce Health Team in Keppra (levetiracetam) —

How to Get Keppra (Levetiracetam) Covered by Humana in Texas: Prior Authorization Guide with Forms and Appeals

Answer Box: Getting Keppra (Levetiracetam) Covered by Humana in Texas

Fastest path to approval: Check if your Humana plan requires prior authorization for generic levetiracetam (usually Tier 1, no PA needed) vs brand Keppra (often Tier 3+ with PA required). Submit PA via Humana's provider portal or call 1-800-451-4651 with diagnosis, seizure type, and prior therapy documentation. If denied, file internal appeal within 65 days, then external review through Medicare appeals process if applicable. Start today: Log into MyHumana to check your formulary status and download PA forms.

Table of Contents

  1. What This Guide Covers
  2. Before You Start: Plan Type and Coverage Check
  3. Gather What You Need
  4. Submit the Prior Authorization Request
  5. Follow-Up and Timelines
  6. If You Need More Information
  7. If Your Request is Denied
  8. Appeals Process for Texas Residents
  9. Renewal and Re-Authorization
  10. FAQ
  11. Quick Reference Checklist

What This Guide Covers

This comprehensive guide helps Texas residents get Keppra (levetiracetam) approved by Humana insurance plans. Whether you need generic levetiracetam or brand Keppra, we'll walk you through the prior authorization process, medical necessity requirements, and appeal options specific to Texas regulations.

Who this helps:

  • Patients with epilepsy or seizure disorders
  • Caregivers managing medication approvals
  • Healthcare providers submitting PA requests
  • Anyone facing Humana coverage denials in Texas

Counterforce Health specializes in turning insurance denials into successful appeals by analyzing denial letters, plan policies, and clinical notes to create targeted, evidence-backed responses. Our platform helps patients, clinicians, and specialty pharmacies navigate complex prior authorization requirements with payer-specific workflows and procedural compliance.

Before You Start: Plan Type and Coverage Check

Step 1: Identify Your Humana Plan Type

Your coverage rules depend on your specific Humana plan:

  • Medicare Advantage (MA): Follow Medicare Part C rules
  • Medicare Part D (PDP): Follow Medicare Part D prescription rules
  • Commercial/Employer: Follow state-regulated insurance rules
  • Medicaid: Follow Texas Medicaid managed care rules

Check your insurance card or log into MyHumana to confirm your plan type.

Step 2: Check Formulary Status

Generic levetiracetam is typically:

  • Tier 1 (lowest copay) on most Humana plans
  • Usually covered without prior authorization
  • Available in multiple strengths and formulations

Brand Keppra often requires:

  • Prior authorization with medical necessity documentation
  • Step therapy (trial of generic first)
  • Higher copays (Tier 3 or non-preferred status)
Tip: Use Humana's Medicare Drug List tool or provider portal to verify current formulary status for your specific plan.

Coverage at a Glance

Requirement Generic Levetiracetam Brand Keppra Where to Check
Prior Auth Usually not required Often required Humana formulary search
Formulary Tier Tier 1-2 (preferred) Tier 3+ (non-preferred) Plan-specific drug list
Step Therapy Rarely Yes (generic first) PA requirements list
Medical Necessity Standard indications Must document generic failure Clinical documentation

Gather What You Need

Essential Documentation

Patient Information:

  • Full name, date of birth, Humana member ID
  • Current address and phone number
  • Prescriber information (name, NPI, contact details)

Clinical Information:

  • Diagnosis with ICD-10 codes (e.g., G40.009 for localization-related epilepsy)
  • Seizure type and frequency before treatment
  • Treatment goals (seizure control, safety, quality of life)

Prior Therapy Documentation:

  • List of previous antiseizure medications tried
  • Doses, durations, and outcomes for each
  • Reasons for discontinuation (lack of efficacy, adverse effects, contraindications)
  • For brand Keppra requests: Specific documentation of generic levetiracetam failure or intolerance

Required Forms

Access current Humana PA forms through:

Submit the Prior Authorization Request

Electronic Submission (Fastest)

  1. Log into Humana provider portal
  2. Navigate to Coverage & Claims → Prior Authorizations
  3. Use the Prior Authorization Search Tool to verify requirements
  4. Submit via electronic PA (ePA) when available

Benefits of ePA:

  • Faster processing (within 1 business day for 95% of complete requests by 2026)
  • Real-time status updates
  • Reduced documentation errors

Phone and Fax Options

Prior Authorization Phone Line: 1-800-451-4651 (TTY 711) Expedited Appeals: 1-800-867-6601

Clean Request Packet Checklist

✅ Completed PA form with all required fields
✅ Prescriber letter of medical necessity (see template below)
✅ Clinical notes supporting diagnosis and treatment history
✅ Lab results if relevant (renal function for dosing)
✅ Prior therapy documentation with specific outcomes
✅ Seizure logs or frequency records

Medical Necessity Letter Template

[Physician Letterhead]
Date: [Current Date]

Re: Prior Authorization Request for Keppra (Levetiracetam)
Patient: [Full Name], DOB: [Date], Member ID: [ID Number]

Dear Humana Medical Review Team,

I am requesting coverage of [generic levetiracetam/brand Keppra] for my patient diagnosed with [specific seizure disorder, ICD-10 code].

CLINICAL BACKGROUND:
- Diagnosis: [Type of epilepsy], confirmed by [EEG/imaging findings]
- Baseline seizure frequency: [Number and type before treatment]
- Treatment goals: Seizure control and improved quality of life

PRIOR TREATMENTS:
[List previous AEDs with doses, durations, and outcomes]

CURRENT REQUEST RATIONALE:
Levetiracetam is medically necessary because:
1. [Specific clinical indication per FDA labeling]
2. [Patient-specific factors favoring this choice]
3. [Prior therapy failures or contraindications]

For brand Keppra requests, include:
- Documented generic levetiracetam trial with specific adverse effects
- Clinical improvement when switched to brand formulation
- Risk of seizure recurrence if forced to use generic

Thank you for your prompt consideration.

Sincerely,
[Prescriber name, credentials, NPI]

Follow-Up and Timelines

Standard Processing Times

Humana Medicare Plans:

  • Standard PA requests: 7 calendar days
  • Expedited requests: 72 hours
  • Part C pre-service: Up to 30 days
  • Part D appeals: 7 days standard

Commercial Plans:

  • Standard requests: 15 business days (Texas regulation)
  • Urgent requests: 72 hours
  • Appeals: 30 days for pre-service, 60 days for post-service

Sample Follow-Up Call Script

"Hello, I'm calling to check the status of a prior authorization request for [patient name], member ID [number], submitted on [date]. The request is for [medication] with reference number [if available]. Can you provide an update on the review timeline?"

Document: Date, time, representative name, reference numbers, and next steps.

If You Need More Information

Common Requests from Humana

Step Therapy Documentation:

  • Proof of generic levetiracetam trial
  • Specific adverse effects or treatment failure
  • Timeline of medication switches

Medical Necessity Clarification:

  • Seizure type confirmation
  • Treatment response documentation
  • Risk assessment without requested medication

Peer-to-Peer Review: If clinical questions arise, request a peer-to-peer discussion between your prescriber and Humana's medical director. This often resolves complex cases faster than written appeals.

If Your Request is Denied

Common Denial Reasons and Solutions

Denial Reason Solution Strategy
"Generic available" Document specific generic failure or intolerance
"Not medically necessary" Provide detailed seizure history and treatment rationale
"Insufficient documentation" Submit comprehensive clinical notes and prior therapy records
"Step therapy not met" Document previous AED trials with specific outcomes

First-Level Appeal Strategy

  1. Review denial letter carefully for specific reasons
  2. Address each denial point with clinical evidence
  3. Include additional documentation: seizure logs, hospital records, EEG reports
  4. Request expedited review if delay risks patient safety

Appeals Process for Texas Residents

Internal Appeals (Required First Step)

Timeline: 180 days from denial to file internal appeal Processing: 30 days for pre-service, 60 days for post-service decisions How to file:

  • Online: Humana member portal
  • Phone: Number on your insurance card
  • Mail: Address provided in denial letter

External Review (Independent Review)

After internal appeal denial, Texas residents can request independent external review:

Timeline: 4 months from final internal denial Processing: 20 days standard, 5 days for urgent cases Cost: Free to patients (insurer pays) How to request: Use IRO form provided with internal denial

Texas Department of Insurance Resources:

  • Consumer Hotline: 1-800-252-3439
  • IRO Information: 1-866-554-4926
  • Website: tdi.texas.gov

Medicare-Specific Appeals

For Humana Medicare Advantage and Part D plans:

  • Level 1: Humana internal review (65 days to file)
  • Level 2: Independent Review Entity
  • Level 3+: Administrative Law Judge, Medicare Appeals Council
Note: ERISA employer plans follow federal rules and may not be subject to Texas external review.

Renewal and Re-Authorization

When to Resubmit

Most PA approvals are valid for:

  • 6-12 months for chronic conditions
  • Annual renewal often required
  • Dose changes may trigger new PA requirement

Renewal Documentation

Include:

  • Treatment response summary (seizure control, side effects)
  • Continued medical necessity rationale
  • Any new clinical developments or comorbidities
  • Updated seizure logs showing ongoing need

Calendar renewal requests 30-60 days before expiration to avoid coverage gaps.

FAQ

Q: How long does Humana prior authorization take in Texas? A: Standard requests take 7 days for Medicare plans, up to 15 business days for commercial plans. Expedited requests are processed within 72 hours.

Q: What if Keppra is not on my formulary? A: Request a formulary exception with medical necessity documentation. Include clinical rationale for why covered alternatives are inappropriate.

Q: Can I get emergency coverage while waiting for approval? A: Yes, request expedited review if delay could seriously harm your health. Some plans offer temporary coverage for urgent situations.

Q: Does step therapy apply if I've been stable on Keppra? A: Existing therapy may be grandfathered under continuity of care provisions. Document prior stability and risks of switching.

Q: What if I'm new to Humana but already taking Keppra? A: Medicare Advantage plans offer 90-day continuity coverage for ongoing treatments. Document that therapy started before enrollment.

Q: How much does brand Keppra cost with Humana? A: Costs vary by plan tier and deductible status. Generic levetiracetam typically costs $10-30 per month, while brand Keppra may cost $100+ without PA approval.

Quick Reference Checklist

Before Submitting PA:

  • Verify plan type and formulary status
  • Check if PA is actually required
  • Gather all clinical documentation
  • Complete appropriate PA form

PA Submission:

  • Use electronic submission when possible
  • Include comprehensive medical necessity letter
  • Document all prior therapy trials
  • Request expedited review if urgent

After Submission:

  • Follow up within 3-5 business days
  • Document all communications
  • Prepare appeal materials if needed
  • Calendar renewal date

If Denied:

  • Review denial reasons carefully
  • File internal appeal within deadline
  • Consider peer-to-peer review
  • Prepare for external review if needed

About Counterforce Health: Counterforce Health helps patients, clinicians, and specialty pharmacies get prescription drugs approved by turning insurance denials into targeted, evidence-backed appeals. Our platform analyzes denial letters, plan policies, and clinical notes to identify denial basis and draft point-by-point rebuttals aligned to each plan's specific rules and requirements.

Sources & Further Reading

Disclaimer: This guide provides educational information about insurance coverage and appeals processes. It is not medical advice and should not replace consultation with your healthcare provider or insurance representative. Coverage policies and requirements may change. Always verify current information with your specific Humana plan and healthcare providers. For personalized assistance with Texas insurance appeals, contact the Texas Department of Insurance at 1-800-252-3439.

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