By Counterforce Health Team in Voydeya (danicopan) —

How to Get Voydeya (danicopan) Covered by Humana in Florida: Forms, Appeals Timeline & Specialty Pharmacy Guide

Quick Answer: Getting Voydeya (danicopan) Covered by Humana in Florida

Voydeya requires prior authorization from Humana with proof of PNH diagnosis, concurrent C5 inhibitor use, and evidence of extravascular hemolysis despite optimized therapy. Submit PA via Humana's PromptPA portal or Availity with flow cytometry results, vaccination records, and specialist attestation. If denied, you have 65 days to appeal internally, then can request external review through Florida's Department of Financial Services. First step today: Call the number on your Humana ID card to verify PA requirements and download the Medicare Prescription Drug Coverage Determination Form.

Table of Contents

Verify Your Plan & Find the Right Forms

Before starting your Voydeya (danicopan) prior authorization, confirm your specific Humana plan requirements. Voydeya is not listed on Humana's 2026 commonly prescribed drug lists, likely placing it in a high-cost specialty tier or requiring a formulary exception.

Coverage at a Glance

Requirement What It Means Where to Find It Source
Prior Authorization Required for all PNH complement inhibitors Humana PA Search Tool Provider portal
Formulary Status Likely non-formulary or Tier 5 Plan-specific formulary Member documents
Specialty Pharmacy Onco360 (Alexion partner) required Voydeya enrollment Manufacturer
REMS Program Mandatory vaccination & monitoring FDA REMS requirements FDA/Alexion

Action Step: Call the number on your Humana ID card and ask specifically about "Voydeya danicopan PA requirements for Florida members."

Prior Authorization Forms & Requirements

Primary Form: Medicare Prescription Drug Coverage Determination

Download the Medicare Prescription Drug Coverage Determination Form (available in English and Spanish). This form covers both initial PA requests and formulary exceptions.

Required Documentation:

  • Member ID and prescriber information
  • ICD-10 diagnosis code for PNH (D59.5)
  • Flow cytometry results confirming PNH diagnosis
  • Documentation of concurrent C5 inhibitor therapy (Soliris/Ultomiris)
  • Evidence of extravascular hemolysis: elevated reticulocytes, persistent anemia, transfusion requirements
  • Vaccination records (meningococcal, pneumococcal, Haemophilus influenzae type b)
  • REMS program enrollment confirmation

Medical Necessity Letter Checklist

Clinician Corner: Your medical necessity letter should address these key points to meet Humana's criteria:Confirmed PNH diagnosis by flow cytometry showing CD55/CD59 deficient cellsCurrent treatment with optimized C5 inhibitor (eculizumab ≥900mg q2w or ravulizumab per weight-based dosing)Evidence of breakthrough extravascular hemolysis: hemoglobin <10 g/dL, elevated reticulocytes >2.5%, LDH elevation, transfusion dependenceDocumentation that patient meets FDA labeling criteria for add-on therapyContraindications to alternative treatments or inadequate response

Submission Portals & Upload Instructions

Primary Submission Methods

1. PromptPA Portal (Recommended)

  • URL: provider.humana.com
  • Best for: Medicare Part D prior authorizations
  • Upload capability: Clinical notes, lab results, vaccination records
  • Tracking: Real-time status updates

2. Availity Portal

  • Access through provider.humana.com
  • Required for professionally administered drugs
  • Use Florida state selector in Prior Authorization Search Tool
  • Submit supporting documents as PDF attachments

3. CoverMyMeds

  • For pharmacy-initiated requests
  • Electronic submission with clinical attachments
  • Direct integration with specialty pharmacies

Upload Requirements

  • File formats: PDF, JPEG, PNG (max 10MB per file)
  • Required attachments: Denial letter (if appealing), clinical notes, lab results, vaccination records
  • Label files clearly: "Patient_LastName_LabResults_Date"

Fax & Mail Options

Fax Submission

Humana Medication Intake Team (MIT)

  • Fax number: Verify current number through provider portal
  • Include cover sheet with member ID, prescriber name, and request type
  • Confirmation: Call to verify receipt within 2 business days

Mail Submission

Address: Humana Grievances and Appeals P.O. Box 14546 Lexington, KY 40512-4546

Include:

  • Completed PA form
  • All supporting documentation
  • Copy of member ID card
  • Self-addressed stamped envelope for confirmation

Specialty Pharmacy Enrollment

Onco360 Enrollment Process

Voydeya is exclusively distributed through Onco360, Alexion's chosen specialty pharmacy partner. This may require network coordination with Humana's preferred CenterWell Specialty Pharmacy.

Step-by-Step Enrollment:

  1. REMS Certification (Prescriber)
    • Complete training at voydeyahcp.com
    • Obtain certification number for PA submission
  2. Patient Enrollment
    • Contact Alexion OneSource at launch
    • Provide insurance information and PA approval
    • Schedule vaccination appointments if needed
  3. Network Verification
    • Confirm Onco360 is in-network with your Humana plan
    • If out-of-network, request single case agreement
    • Contact CenterWell Specialty Pharmacy for potential transfer options

Transfer Instructions

If currently using CVS/Caremark or AccredoHealth for other specialty medications:

  • Coordinate with both pharmacies to ensure no gap in therapy
  • Transfer prescription and remaining refills
  • Update automatic refill preferences
  • Confirm copay assistance programs transfer

Support Lines & Contact Information

Member Support

Primary Contact: Number on back of Humana ID card General Inquiry: 800-867-6601 (TTY: 711) Hours: Monday-Friday, 8 a.m.-8 p.m. ET

Florida-Specific Contacts

Humana Healthy Horizons Florida (if applicable):

  • Customer Care: 800-477-6931 (TTY: 711)
  • Appeals/Grievances: 888-259-6779
  • Hours: Monday-Friday, 8 a.m.-8 p.m. ET

Provider Support

Humana Provider Services: 800-448-6262 CenterWell Specialty: Monday-Friday 8 a.m.-11 p.m., Saturday 8 a.m.-6:30 p.m. ET Fax: 877-405-7940

What to Ask When You Call

  • "What are the specific PA criteria for Voydeya danicopan?"
  • "Is Onco360 in my network for specialty pharmacy?"
  • "What's the timeline for PA decisions?"
  • "Can I request an expedited review?"

Florida Appeals & External Review Process

Internal Appeals Timeline

If your initial PA is denied, you have 65 days from the denial notice to file an internal appeal with Humana.

Submission Methods:

  • Online: Humana member portal
  • Phone: 888-259-6779 (Florida Medicaid) or number on ID card
  • Mail: Humana Grievances and Appeals, P.O. Box 14546, Lexington, KY 40512-4546

Required for Appeal:

  • Original denial letter
  • Updated clinical documentation
  • Prescriber letter addressing specific denial reasons
  • Any new lab results or treatment history

External Review Through Florida DFS

After exhausting Humana's internal appeal process, Florida residents can request an independent external review through the Department of Financial Services.

Timeline & Process:

  • Filing deadline: 4 months from final internal denial
  • Contact: 877-693-5236 (Florida Insurance Consumer Helpline)
  • Review timeline: 45 days standard, 72 hours expedited
  • Cost: Free for federal external review process
  • Decision: Binding on Humana if favorable
From our advocates: We've seen external reviews succeed for rare disease drugs when the appeal includes updated clinical guidelines, peer-reviewed studies showing efficacy, and detailed documentation of why formulary alternatives are unsuitable. The key is demonstrating that the denial contradicts established medical standards of care.

When to Request Expedited Review

Request expedited processing if:

  • Delay could seriously jeopardize your health
  • Current PNH symptoms are worsening despite C5 inhibitor therapy
  • You're experiencing frequent hemolytic crises
  • Standard timeline could reduce effectiveness of treatment

When to Check for Updates

Quarterly Review Schedule

  • January: New formulary updates and PA criteria changes
  • April: Mid-year policy adjustments
  • July: Prepare for next year's plan changes
  • October: Open enrollment formulary reviews

What to Monitor

  • Humana formulary updates
  • FDA label changes for Voydeya
  • New clinical guidelines from hematology societies
  • Florida insurance regulation changes

Setting Up Alerts

  • Subscribe to Humana provider updates
  • Monitor Alexion's professional site for coverage support updates
  • Follow Florida DFS insurance alerts

FAQ

How long does Humana PA take for Voydeya in Florida? Standard PA decisions are made within 72 hours for urgent requests, 7 days for non-urgent. Medicare Part D redeterminations must be completed within 7 days of submission.

What if Voydeya is non-formulary on my Humana plan? Submit a formulary exception request with your PA. Include documentation showing why formulary alternatives (other PNH treatments) are medically inappropriate or have failed.

Can I request a peer-to-peer review? Yes, ask your hematologist to request a peer-to-peer review with Humana's medical director. This can be particularly effective for complex rare disease cases.

Does step therapy apply if I've tried other PNH treatments outside Florida? Medical records from any state should count toward step therapy requirements. Ensure all prior treatment documentation is included in your PA submission.

What if I can't afford the copay even with approval? Contact Alexion OneSource about patient assistance programs. The PAN Foundation may also offer copay support for PNH treatments.

How do I know if my appeal was successful? Humana will send written notification within 5 business days of their decision. You can also track status through their online portal or by calling the number on your ID card.

Counterforce Health helps patients, clinicians, and specialty pharmacies turn insurance denials into targeted, evidence-backed appeals. Our platform analyzes denial letters and payer policies to create compelling medical necessity arguments that align with each plan's specific requirements, saving time and improving approval rates for complex treatments like Voydeya.

For additional support with your Voydeya appeal, visit www.counterforcehealth.org to learn how our platform can help strengthen your case with payer-specific evidence and streamlined submission processes.

Sources & Further Reading

Disclaimer: This information is for educational purposes only and does not constitute medical or legal advice. Always consult with your healthcare provider and insurance plan for specific coverage decisions. Appeals processes and coverage criteria may change; verify current requirements with your insurer and Florida's Department of Financial Services.

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