Topic

Humana

A collection of 1087 issues

How to Get Opdivo (Nivolumab) Covered by Humana in Ohio: Prior Authorization, Appeals & Exception Strategies

Quick Answer: Opdivo (nivolumab) requires prior authorization from Humana in Ohio, with approval typically taking 72 hours (24 hours expedited). Success depends on documenting FDA-approved indication, biomarker testing, prior therapy failures, and medical necessity. If denied, you have 65 days to appeal internally, then 180 days for Ohio external review.

How to Get Ultomiris (Ravulizumab) Covered by Humana in Texas: Coding, Appeals, and Prior Authorization Guide

Answer Box: Getting Ultomiris Covered by Humana in Texas Ultomiris (ravulizumab) requires prior authorization from Humana Medicare Advantage plans in Texas. The fastest path to approval: 1) Submit PA request through Humana's provider portal with diagnosis-specific ICD-10 codes (D59.5 for PNH, D59.3 for aHUS, G70.0

How to Get Daybue (trofinetide) Covered by Humana in New York: Complete PA Guide and Appeals Process

Quick Answer: Humana covers Daybue (trofinetide) for Rett syndrome with mandatory prior authorization requiring genetic testing confirmation (MECP2 mutation), specialist documentation, and clinical severity scores. Standard PA decisions take up to 14 days in 2024 (7 days starting 2025). If denied, you have 65 days to appeal internally, then can

How to Get Raxone (Idebenone) Covered by Humana in New Jersey: Appeals Guide & Alternative Options

Answer Box: Getting Raxone Covered by Humana in New Jersey Quick Summary: Raxone (idebenone) is not FDA-approved in the US, making coverage challenging but possible through formulary exceptions or compassionate use. In New Jersey, you have strong appeal rights through IHCAP if initially denied. Fastest Path: 1. Request a formulary

Myths vs. Facts: Getting Opsumit (Macitentan) Covered by Humana in North Carolina

Answer Box: Humana Medicare Advantage members in North Carolina cannot use Smart NC external review and must follow federal Medicare appeals. Commercial Humana plan members may qualify for Smart NC's free external review process. For Opsumit (macitentan), expect prior authorization requiring WHO Group 1 PAH diagnosis, specialist prescriber,

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

Answer Box: Getting Lamzede Covered by Humana in Ohio Fastest path to approval: Submit prior authorization through Humana's provider portal with confirmed alpha-mannosidosis diagnosis (enzyme assay + MAN2B1 genetics), functional assessments (6-minute walk test, pulmonary function), and specialist letter of medical necessity. Standard decisions take 30 days; expedited reviews

How to Get Elzonris (tagraxofusp-erzs) Covered by Humana in Texas: Prior Authorization, Appeals, and Formulary Exception Guide

Answer Box: Getting Elzonris Approved by Humana in Texas Elzonris (tagraxofusp-erzs) requires prior authorization from Humana Medicare Advantage plans and often needs a formulary exception since it's not on standard Part D formularies. Key requirements: CD123-positive BPDCN diagnosis, baseline albumin ≥3.2 g/dL, and capillary leak syndrome

How to Get Ferriprox (deferiprone) Covered by Humana in Illinois: Complete Guide with ICD-10 Codes, Prior Authorization, and Appeals

Answer Box: Getting Ferriprox (deferiprone) Covered by Humana in Illinois Ferriprox (deferiprone) requires prior authorization from Humana and is typically covered as a specialty Part D drug when medically necessary for transfusional iron overload. Fastest path to approval: Have your hematologist submit a PA request with diagnosis codes E83.111

How to Get Elfabrio (Pegunigalsidase Alfa) Covered by Humana in Illinois: Renewal Guide and Appeal Timeline

Answer Box: Renewing Elfabrio Coverage with Humana in Illinois Start your Elfabrio renewal 30-45 days before expiration. Humana typically approves enzyme replacement therapy for 6-12 month periods requiring updated documentation. First step today: Check your current authorization end date via Humana's member portal or call 800-867-6601. Gather recent

Do You Qualify for Vyndaqel/Vyndamax (Tafamidis) Coverage by Humana in Florida? Complete Decision Tree & Appeals Guide

Answer Box: Your Fastest Path to Approval To get Vyndaqel/Vyndamax covered by Humana in Florida, you need: confirmed ATTR-CM diagnosis (PYP scan grade 2-3 or biopsy), NYHA Class I-III heart failure, and cardiology oversight. First step today: Have your cardiologist submit prior authorization via Humana's provider portal