Topic

Florida

A collection of 395 issues

Getting Firdapse (Amifampridine) Covered by Humana in Florida: PA Requirements, Appeals Timeline, and Cost Support

Quick Answer: Humana requires prior authorization for Firdapse (amifampridine) to treat Lambert-Eaton myasthenic syndrome (LEMS). You'll need confirmed LEMS diagnosis via antibody testing and EMG, neuromuscular specialist documentation, and evidence of medical necessity. If denied, file a redetermination appeal within 65 days. Start today: Call Humana member services
5 min read

How to Get Tegsedi (inotersen) Covered by UnitedHealthcare in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tegsedi (inotersen) Approved by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Tegsedi (inotersen) with strict criteria: confirmed hATTR polyneuropathy (ICD-10 E85.1), pathogenic TTR mutation, neurologist involvement, and REMS enrollment. No step therapy required, but baseline labs and monitoring plan are mandatory. First step: Gather genetic
6 min read

How to Get Stelara (Ustekinumab) Covered by UnitedHealthcare in Florida: Complete Guide to Prior Authorization, Appeals, and Specialty Pharmacy Requirements

Answer Box: Getting Stelara Covered by UnitedHealthcare in Florida UnitedHealthcare now requires biosimilar ustekinumab (Steqeyma or Yesintek) instead of brand Stelara for most commercial plans as of September 2024. To get coverage: 1) Have your doctor submit prior authorization through the UHC Provider Portal documenting moderate-to-severe disease and failure of
6 min read

How to Get Chenodal (Chenodiol) Covered by Humana in Florida: Complete Prior Authorization Guide with Appeals Process

Answer Box: Getting Chenodal Covered by Humana in Florida Humana requires prior authorization for Chenodal (chenodiol) in Florida for FDA-approved uses like radiolucent gallstones or cerebrotendinous xanthomatosis (CTX). Submit the Request for Medicare Prescription Drug Coverage Determination form with imaging confirming radiolucent stones, documented ursodiol failure (≥6 months), and surgical
6 min read

Florida Blue Cross Blue Shield Coverage for Oxlumo (Lumasiran): Complete Prior Authorization and Appeals Guide 2025

Answer Box: Getting Oxlumo Covered by Florida Blue Cross Blue Shield Florida Blue requires prior authorization for Oxlumo (lumasiran) with strict medical necessity criteria: confirmed PH1 diagnosis via genetic testing, elevated baseline urinary/plasma oxalate levels, specialist prescriber, and pyridoxine trial (unless contraindicated). Fastest path: Have your nephrologist submit PA
7 min read