Topic

Humana

A collection of 133 issues

Work With Your Doctor to Get Retevmo (selpercatinib) Covered by Humana in California: Templates, Timelines & Appeal Scripts

Quick Answer: Getting Retevmo (selpercatinib) Covered by Humana in California Humana Medicare Advantage requires prior authorization for Retevmo (selpercatinib) for RET fusion-positive cancers. Your oncologist must submit documentation proving RET alteration status through Evolent's portal or by calling 844-926-4528. If denied, you have 65 days to appeal and

How to Get Synagis (Palivizumab) Covered by Humana in Michigan: Complete Authorization Guide

Answer Box: Getting Synagis Covered by Humana in Michigan Synagis (palivizumab) requires prior authorization from Humana for high-risk infants. The fastest path to approval: 1) Confirm your child meets high-risk criteria (premature birth ≤35 weeks, chronic lung disease, or significant heart conditions), 2) Have your pediatrician submit the prior authorization

How to Get Cabometyx (Cabozantinib) Covered by Humana in Washington: Complete Appeals Guide

Answer Box: Fastest Path to Approval Cabometyx (cabozantinib) requires prior authorization from Humana Medicare Advantage in Washington. Your oncologist must submit clinical documentation showing medical necessity, often including step therapy completion. If denied, you have 65 days to appeal internally, then can request external review through Washington's Independent

How to Renew Skyrizi (Risankizumab) Coverage with Humana in Georgia: 2025 Timeline and Appeals Guide

Answer Box: Skyrizi Renewal with Humana in Georgia Skyrizi (risankizumab) renewal with Humana requires updated clinical documentation submitted before your current authorization expires—typically every 12 months. Start the renewal process 60-90 days early to avoid therapy gaps. If denied, you have 60 days to appeal through Humana's

How to Get Poteligeo (mogamulizumab-kpkc) Covered by Humana in Illinois: Timeline, Appeals, and Approval Scripts

Answer Box: Getting Poteligeo (mogamulizumab-kpkc) Covered by Humana in Illinois Fastest path to approval: Submit prior authorization through your oncologist/dermatologist with documented relapsed/refractory mycosis fungoides or Sézary syndrome after ≥1 prior systemic therapy. Humana typically decides within 14 days (7 days starting 2026). First step today: Have your

How to Get Turalio (Pexidartinib) Covered by Humana in California: Prior Authorization Guide

Answer Box: Getting Turalio Covered by Humana in California Turalio (pexidartinib) requires prior authorization from Humana and is typically placed on Tier 5 (specialty tier). To get approved in California: 1. Complete REMS enrollment - Both prescriber and patient must enroll in the Turalio REMS Program 2. Submit comprehensive PA

How to Get Darzalex Covered by Humana in New York: Step Therapy Laws, Appeals Process, and Prior Authorization Guide

Answer Box: Getting Darzalex Covered by Humana in New York Darzalex (daratumumab) requires prior authorization from Humana Medicare Advantage plans in New York. If denied, you can appeal internally and request external review through the New York Department of Financial Services (DFS) within four months. New York's step

Getting Kuvan (Sapropterin) Covered by Humana in North Carolina: Complete Coding & Appeals Guide

Quick Answer: Your Path to Kuvan Coverage Kuvan (sapropterin) requires prior authorization from Humana, billed under Medicare Part D using NDC codes (not J-codes). Key steps: 1) Ensure correct ICD-10 coding (E70.0 for classical PKU, E70.1 for other hyperphenylalaninemia), 2) Submit weight-based dosing documentation with specialist confirmation, 3)

How to Get Arikayce Covered by Humana in California: Prior Authorization Guide and Appeal Process

Quick Answer: Getting Arikayce Covered by Humana in California Humana requires prior authorization for Arikayce (amikacin liposome inhalation) with strict documentation of refractory MAC lung disease. Your fastest path to approval: 1) Gather 6+ months of failed standard therapy records, 2) Submit PA request with detailed medical necessity letter through

Getting Therakos CELLEX Photopheresis Covered by Humana in Illinois: Complete Guide to Prior Authorization and Appeals

Quick Answer: Therakos CELLEX photopheresis requires prior authorization from Humana for CTCL and steroid-refractory GVHD. Submit complete clinical documentation showing diagnosis, failed prior treatments, and specialist oversight through Humana's provider portal. If denied, you have 65 days to appeal, with Illinois offering external review within 30 days. Start