Topic

Humana

A collection of 1244 issues

Myths vs. Facts: Getting Duopa (Carbidopa/Levodopa Enteral) Covered by Humana in Illinois

Answer Box: Fast Track to Duopa Coverage in Illinois Getting Duopa covered by Humana in Illinois requires: documented advanced Parkinson's with ≥4 hours daily OFF time despite optimized oral therapy, PEG-J surgical clearance, and proper J7340 coding. Fastest path: Submit comprehensive motor fluctuation logs (1-2 weeks), failed oral

How to Get Tegsedi (Inotersen) Covered by Humana in Virginia: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Tegsedi (Inotersen) Covered by Humana in Virginia Tegsedi (inotersen) requires prior authorization from Humana Medicare Advantage and Part D plans. The fastest path to approval involves three key steps: (1) Ensure your prescriber enrolls in the FDA's Tegsedi REMS program and submits baseline lab results,

If Opfolda (miglustat) Isn't Approved by Humana in Michigan: Formulary Alternatives & Exception Paths

Answer Box: When Humana Denies Opfolda (miglustat) If Humana denies Opfolda (miglustat) for late-onset Pompe disease in Michigan, standard enzyme replacement therapies like Nexviazyme or Lumizyme serve as formulary alternatives. Request a formulary exception via the "Request for Medicare Prescription Drug Coverage Determination" form (fax 877-486-2621) with medical

Getting StrataGraft Covered by Humana in Florida: Complete Prior Authorization and Appeals Guide

Quick Answer: Your Path to StrataGraft Coverage StrataGraft requires prior authorization through Humana's Medicare Part B medical benefit (not pharmacy) for deep partial-thickness thermal burns in adults. Submit via Humana's provider portal with burn assessment photos, failed therapy documentation, and surgical rationale within 65 days of

Myths vs. Facts: Getting Strensiq (asfotase alfa) Covered by Humana in New Jersey

Answer Box: Getting Strensiq Covered by Humana in New Jersey Strensiq (asfotase alfa) requires prior authorization from Humana and is typically non-formulary, but coverage is possible for pediatric/juvenile-onset hypophosphatasia with proper documentation. Your prescriber must submit both a prior authorization AND formulary exception request with genetic testing results, low

Work With Your Doctor to Get Nucala (Mepolizumab) Approved by Humana in Michigan: Complete Provider Collaboration Guide

Answer Box: Getting Nucala Covered by Humana in Michigan Humana requires prior authorization for Nucala (mepolizumab) with specific criteria: blood eosinophils ≥150 cells/μL, severe asthma despite high-dose ICS/LABA therapy, and ≥2 exacerbations requiring systemic steroids annually. Your pulmonologist or allergist must submit documentation via Humana's provider

How to Get Luxturna (Voretigene Neparvovec-rzyl) Covered by Humana in Pennsylvania: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Luxturna Covered by Humana in Pennsylvania Humana Medicare plans require prior authorization for Luxturna (voretigene neparvovec-rzyl) with specific genetic testing and facility requirements. Key steps: (1) Confirm biallelic RPE65 mutations via authorized lab testing, (2) Schedule evaluation at UPMC Eye Center or CHOP, and (3) Submit prior

Getting Haegarda Covered by Humana in North Carolina: Complete Prior Authorization Guide (2025)

Answer Box: Fast Track to Haegarda Coverage Humana requires prior authorization for Haegarda (C1-esterase inhibitor, subcutaneous) in North Carolina. Your fastest path: Submit PA through Humana's provider portal with confirmed HAE diagnosis (low C4, abnormal C1-INH levels), documented attack history, and completed injection training. If denied, appeal within

How to Get Bylvay (Odevixibat) Covered by Humana in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Bylvay (Odevixibat) Covered by Humana in Michigan Humana requires prior authorization for Bylvay (odevixibat) to treat pruritus in PFIC (≥3 months) or Alagille syndrome (≥12 months). Submit PA via Humana's provider portal with specialist documentation, diagnosis confirmation, pruritus severity scores, and prior treatment failures. If

How to Get Skyrizi (Risankizumab) Covered by Humana in Ohio: Prior Authorization, Appeals, and Formulary Alternatives

Quick Answer: Getting Skyrizi Covered by Humana in Ohio Skyrizi (risankizumab) is covered by Humana as a Tier 5 specialty drug but requires prior authorization (PA), step therapy (TNF inhibitor failure), and quantity limits. In Ohio, you have 65 days to appeal denials internally, then 180 days for external review