Topic

Eloctate (coagulation factor VIII, rFVIIIFc; efmoroctocog alfa)

A collection of 2 issues

Get Eloctate Covered by Humana in Michigan: Prior Authorization Forms, Appeal Process & Medical Necessity Letters

Quick Answer: Eloctate requires prior authorization from Humana in Michigan. Your hematologist must submit a PA request with clinical documentation showing medical necessity. If denied, you have 65 days to appeal internally, then 127 days for Michigan DIFS external review. Start by gathering your diagnosis, bleeding history, and prior treatment

How to Get Eloctate Covered by Blue Cross Blue Shield of Texas: Medical Necessity Criteria and Appeal Guide

Quick Answer: Blue Cross Blue Shield of Texas requires prior authorization for Eloctate (efmoroctocog alfa) and lists it as non-preferred, meaning you'll likely need to try preferred alternatives like Adynovate or Jivi first. To get coverage, your hematologist must document hemophilia A diagnosis, failed preferred therapies, and medical