Topic

Humana

A collection of 1071 issues

How to Get Uptravi (selexipag) Covered by Humana in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Started Today To get Uptravi (selexipag) covered by Humana in New Jersey: (1) Confirm WHO Group I PAH diagnosis with right heart catheterization data, (2) Document WHO Functional Class II-IV and failed trials of at least two PAH drug classes, (3) Submit prior authorization via Humana'

If Rapivab (Peramivir) Isn't Approved by Humana in Texas: Formulary Alternatives & Exception Paths

Answer Box: Quick Path to Coverage If Humana denies Rapivab (peramivir) in Texas: First, try formulary alternatives like oseltamivir (generic Tamiflu) or baloxavir (Xofluza). If alternatives fail or are contraindicated, request an exception with a medical necessity letter documenting why IV therapy is required. Next step: Call Humana at 800-867-6601

How to Get Filspari (sparsentan) Covered by Humana in Ohio: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Filspari Covered by Humana in Ohio Filspari (sparsentan) requires prior authorization from Humana with mandatory REMS enrollment and IgA nephropathy documentation. Submit PA through Humana's provider portal with kidney biopsy, UPCR ≥0.5-0.8 g/g, ACE/ARB failure records, and baseline liver tests. If

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

Answer Box: Getting Gattex (Teduglutide) Covered by Humana in Washington Humana requires prior authorization (PA) for Gattex (teduglutide) for short bowel syndrome with parenteral nutrition dependence. Your gastroenterologist submits PA electronically via Humana's provider portal with documented SBS diagnosis, 12+ months of PN logs, recent colonoscopy, and failed

How to Get Blenrep (Belantamab Mafodotin) Covered by Humana in Texas: PA Requirements, Appeals, and Approval Scripts

Answer Box: Getting Blenrep Covered by Humana in Texas Current Status: Blenrep (belantamab mafodotin) was withdrawn from US markets in 2022 and is only available through clinical trials or expanded access programs. Humana typically denies coverage outside study settings. If pursuing expanded access: (1) Submit prior authorization via Humana'

How to Get Zolgensma Covered by Humana in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by Humana in Georgia Fastest path: Submit prior authorization through Humana's medical benefit using HCPCS J3399 with complete genetic testing (SMN1 mutation confirmation), AAV9 antibody results, and specialist letter of medical necessity. Standard decision within 14-30 days; expedited within 72 hours if delay

How to Get Galafold (Migalastat) Covered by Humana in North Carolina: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Galafold Covered by Humana in North Carolina Galafold (migalastat) requires prior authorization from Humana for adults with Fabry disease and confirmed amenable GLA variants. First step: Have your specialist submit a PA request with genetic testing showing an amenable variant, clinical documentation of Fabry symptoms, and why

How to Get Uptravi (selexipag) Covered by Humana in Illinois: A Real-World Approval Guide

Answer Box: Getting Uptravi Covered by Humana in Illinois Humana Medicare Advantage typically requires prior authorization for Uptravi (selexipag) for pulmonary arterial hypertension. Fastest path: Submit Humana's Medicare Prescription Drug Coverage Determination form with detailed clinical documentation showing WHO Group I PAH diagnosis, hemodynamic data, prior therapy trials,

Work With Your Doctor to Get Vigabatrin (Sabril) Approved by Humana in North Carolina: Complete Provider Partnership Guide

Answer Box: Getting Vigabatrin Covered by Humana in North Carolina Eligibility: Vigabatrin requires prior authorization from Humana for infantile spasms (ages 1 month-2 years) or refractory complex partial seizures (≥2 years). Fastest path: Schedule a focused appointment with your neurologist to document failed treatments, gather REMS enrollment proof, and submit

How to Get Lamzede (velmanase alfa-tycv) Covered by Humana in Illinois: Complete PA Guide and Appeal Process

Answer Box: Fastest Path to Lamzede Coverage Humana requires prior authorization for Lamzede (velmanase alfa-tycv) with strict medical necessity criteria. You'll need: confirmed alpha-mannosidosis diagnosis (enzyme activity <10% normal + biallelic MAN2B1 variants), documented non-CNS manifestations, baseline functional tests (6-minute walk test, pulmonary function), and specialist letter. Standard