Topic

Humana

A collection of 600 issues

Getting Zanzalintinib (XL092) Covered by Humana in Texas: Appeals Process and State Protections

Quick Answer: Getting Zanzalintinib (XL092) Covered by Humana in Texas Zanzalintinib (XL092) is an investigational drug typically denied by Humana outside clinical trials. However, Texas law provides strong appeal rights for investigational treatments. Your fastest path: Request a formulary exception with clinical documentation, then if denied, file for Texas Independent

How to Get Tecentriq (atezolizumab) Covered by Humana in Illinois: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Getting Tecentriq Covered by Humana in Illinois Tecentriq (atezolizumab) requires prior authorization from Humana and must be dispensed through specialty pharmacies like CenterWell. In Illinois, if denied, you have 65 days to appeal and can request an independent external review within 30 days of a final denial. First

How to Get Breyanzi Covered by Humana in North Carolina: Appeals Guide & Templates

Answer Box: Getting Breyanzi Covered by Humana in North Carolina Fastest path to approval: Submit prior authorization to Humana's Transplant Network (fax: 502-508-9300) with complete clinical documentation showing you meet FDA-approved indications for large B-cell lymphoma or CLL after ≥2 prior therapies. If denied, you have 65 days

How to Get Translarna (Ataluren) Covered by Humana in New York: Timeline, Appeals & Required Documentation

Quick Answer: Getting Translarna (Ataluren) Covered by Humana in New York Timeline: 14 days for standard prior authorization (reducing to 7 days in 2026), 72 hours for urgent requests. Requirements: Genetic testing confirming nonsense mutation DMD, 6-minute walk test results, specialist prescription, and annual renewal documentation. First step: Contact your

How to Get Tegsedi (Inotersen) Covered by Humana in Ohio: Prior Authorization, Appeals, and REMS Requirements

Answer Box: Get Tegsedi (Inotersen) Covered by Humana in Ohio Humana requires prior authorization for Tegsedi (inotersen) for hATTR polyneuropathy in Ohio. Your fastest path to approval: 1) Ensure REMS program enrollment (both prescriber and patient), 2) Submit complete PA request with genetic testing confirmation and lab monitoring plan, 3)

How to Get Amvuttra (Vutrisiran) Covered by Humana in Michigan: Appeals, Alternatives, and Exception Strategies

Quick Answer: Getting Amvuttra (Vutrisiran) Approved by Humana in Michigan Amvuttra (vutrisiran) requires prior authorization from Humana for hereditary transthyretin-mediated amyloidosis with polyneuropathy (hATTR-PN). Most Humana Medicare plans don't list Amvuttra on their 2025 formularies, making a formulary exception request necessary. Your fastest path: (1) Have your prescriber

If Hemlibra Isn't Approved by Humana in Illinois: Formulary Alternatives & Exception Paths

Answer Box: Quick Path to Coverage When Humana denies Hemlibra (emicizumab-kxwh) in Illinois, you typically need to try their preferred factor VIII products first due to step therapy requirements. Fastest approval path: Document failure or contraindications to preferred alternatives (Eloctate, Advate, Jivi), then request a formulary exception with medical necessity

Coding That Gets Vyondys 53 (Golodirsen) Approved by Humana in Georgia: ICD-10, J-Code & NDC Guide

Answer Box: Fast Track to Vyondys 53 Coverage Getting Vyondys 53 (golodirsen) approved by Humana in Georgia requires precise medical coding and documentation. Use ICD-10 code G71.01 for Duchenne muscular dystrophy, HCPCS J1429 for billing (10mg units), and NDC 60923-0465-01. Submit genetic testing confirming exon 53-skippable mutation with your

Myths vs. Facts: Getting Spinraza (Nusinersen) Covered by Humana in New York

Answer Box: Spinraza Coverage Through Humana in New York Spinraza (nusinersen) requires prior authorization from Humana and must be prescribed by a neurologist with SMA expertise. Key requirements include genetic confirmation of 5q SMA, baseline motor function testing, and comprehensive clinical documentation. If denied, New York patients have strong appeal

How to Get Krystexxa (Pegloticase) Covered by Humana in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Krystexxa Covered by Humana in California Krystexxa (pegloticase) requires prior authorization for all Humana Medicare Advantage plans in California. The fastest path to approval: 1) Ensure you have a rheumatologist prescriber, documented failure of allopurinol and febuxostat, normal G6PD test results, and current methotrexate therapy (unless contraindicated)