Topic

Humana

A collection of 126 issues

Getting Venclexta (venetoclax) Covered by Humana in New Jersey: Prior Authorization, Appeals, and Medical Necessity Guide

Answer Box: Fast Track to Venclexta Coverage To get Venclexta (venetoclax) covered by Humana in New Jersey: Your doctor must submit prior authorization with clinical documentation showing medical necessity, including diagnosis (CLL/AML), tumor lysis syndrome monitoring plan, and justification for why formulary alternatives won't work. Submit via

How to Get Besponsa (Inotuzumab Ozogamicin) Covered by Humana in North Carolina: Complete Guide to Prior Authorization, Appeals, and Billing Codes

Answer Box: Getting Besponsa Covered by Humana in North Carolina Besponsa (inotuzumab ozogamicin) requires prior authorization through Evolent/New Century Health for all Humana Medicare Advantage plans. Submit requests via their portal at my.newcenturyhealth.com or call 844-926-4528 (option 5). Required documentation includes CD22-positive B-cell ALL diagnosis (ICD-10: C91.

How to Get Mavenclad (Cladribine) Covered by Humana in North Carolina: Complete Prior Authorization Guide

Answer Box: Your Path to Mavenclad Coverage Mavenclad (cladribine tablets) requires prior authorization from Humana and is subject to step therapy requirements. In North Carolina, you have 65 days to appeal denials through Humana's internal process, then 120 days to file external review with Smart NC. First step

How to Get Dojolvi (Triheptanoin) Covered by Humana in Georgia: Complete Coding and Appeal Guide

Answer Box: Getting Dojolvi (Triheptanoin) Covered by Humana in Georgia Dojolvi (triheptanoin) requires prior authorization from Humana Medicare Advantage, billed under NDC 69794-0050-50 with ICD-10 codes E71.310 or E71.318. Your prescriber must submit molecular genetic confirmation of long-chain fatty acid oxidation disorder (LC-FAOD) plus clinical documentation. If denied,

How to Get Evkeeza (Evinacumab-dgnb) Covered by Humana in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Evkeeza Covered by Humana in New York Evkeeza (evinacumab-dgnb) is covered by Humana Medicare Advantage plans but requires prior authorization. For fastest approval: (1) Your provider submits genetic testing results confirming homozygous familial hypercholesterolemia (HoFH), documented LDL-C levels >400-500 mg/dL, and records of maximally tolerated

Renewing Emgality (galcanezumab-gnlm) Approval with Humana in North Carolina: Timeline, Documents & Bridge Options

Answer Box: Renewing Emgality Coverage with Humana in North Carolina Start your renewal 30 days before expiration to avoid therapy gaps. Humana requires updated headache diaries showing continued benefit, provider documentation of ongoing medical necessity, and submission through their Clinical Pharmacy Review portal. If denied, North Carolina residents can appeal

How to Get Zolgensma (Onasemnogene Abeparvovec) Covered by Humana in North Carolina: Complete Prior Authorization Guide

Quick Answer: Humana requires prior authorization for Zolgensma (onasemnogene abeparvovec) in North Carolina with strict age (<2 years), genetic testing, and clinical documentation requirements. Submit through Humana's provider portal with complete SMN1 testing, anti-AAV9 titers, and specialist consultation. If denied, use North Carolina's Smart NC

How to Get Soliris (Eculizumab) Covered by Humana in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Soliris (Eculizumab) Covered by Humana in Pennsylvania Yes, Humana covers Soliris (eculizumab) in Pennsylvania, but requires strict prior authorization. The medication typically falls under Tier 5 (specialty tier) with 25-33% coinsurance. Your fastest path to approval: 1) Ensure meningococcal vaccination is completed at least 2 weeks before

How to Get Oxlumo (Lumasiran) Covered by Humana in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Oxlumo (Lumasiran) Covered by Humana in Washington Oxlumo requires prior authorization from Humana for primary hyperoxaluria type 1 (PH1). The fastest path to approval: (1) Confirm PH1 diagnosis with genetic testing showing AGXT mutations or liver enzyme analysis, (2) Document elevated urinary oxalate levels (>0.7

How to Get Turalio (Pexidartinib) Covered by Humana in New York: Coding, Prior Authorization, and Appeals Guide

Answer Box: Getting Turalio Covered by Humana in New York Turalio (pexidartinib) requires prior authorization from Humana for tenosynovial giant cell tumor (TGCT) when surgery isn't an option. First step today: Ensure your prescriber is REMS-certified and gather baseline liver function tests. Submit PA via Humana's