Topic

Humana

A collection of 126 issues

How to Get Orladeyo (Berotralstat) Covered by Humana in Washington: Timeline, Appeals & Forms

Answer Box: Getting Orladeyo Covered by Humana in Washington Orladeyo (berotralstat) is typically covered by Humana as a specialty tier drug requiring prior authorization for hereditary angioedema (HAE) prophylaxis. The fastest path to approval involves: 1) Confirming HAE diagnosis with lab results (C1-INH levels/function), 2) Submitting complete prior authorization

Renewing Zanzalintinib (XL092) Coverage with Humana in Washington: Timeline, Documentation & Appeal Steps

Answer Box: Renewing Zanzalintinib (XL092) Coverage with Humana in Washington Zanzalintinib (XL092) is an investigational drug requiring compassionate use program enrollment through Exelixis, as it's not FDA-approved. Humana typically covers investigational drugs only within clinical trials or approved compassionate use programs. To renew coverage: (1) Confirm continued eligibility

Garadacimab (Andembry) Coverage by Humana in Texas: Formulary Alternatives, Appeals, and Prior Authorization Guide

Quick Answer: Getting Garadacimab (Andembry) Covered by Humana in Texas Garadacimab is not on Humana's 2025 Medicare formulary, requiring a formulary exception request. Texas residents have strong appeal rights through internal reviews (65 days to file) and external reviews via Independent Review Organizations. First step: Have your prescriber

Renewing Vitrakvi (Larotrectinib) Approval with Humana in Washington: Timeline, Documentation & Appeals Guide

Answer Box: Renewing Vitrakvi Coverage with Humana in Washington Vitrakvi (larotrectinib) requires prior authorization renewal with Humana every 3-6 months. Start your renewal 30-45 days before expiration. Submit: updated clinical notes showing continued benefit, recent imaging demonstrating response/stable disease, current liver function tests, and NTRK fusion documentation. If denied,

How to Get Cabometyx (Cabozantinib) Covered by Humana in Ohio: Complete PA Guide and Appeals Process

Quick Answer: Cabometyx (cabozantinib) requires prior authorization from Humana in Ohio. Your oncologist must submit clinical documentation including diagnosis, staging, prior therapies, and medical necessity justification. If denied, you have 65 days to appeal internally, then can request external review through Ohio's Department of Insurance. Start by having

How Long Does It Take to Get Signifor LAR (Pasireotide) Approved by Humana in New York? Timeline & Appeal Process

Answer Box: Getting Signifor LAR Covered by Humana in New York Timeline: Humana Medicare Advantage must decide on Signifor LAR (pasireotide) prior authorization within 7 calendar days (standard) or 72 hours (expedited) starting January 2026. Currently, most electronic submissions get responses within one business day. Fastest path: Submit complete documentation

Get Photrexa (Riboflavin) Covered by Humana in Virginia: Prior Authorization Guide

Quick Answer: Getting Photrexa Covered by Humana in Virginia Humana requires prior authorization for Photrexa (riboflavin) corneal crosslinking procedures. Your ophthalmologist must submit documentation proving progressive keratoconus with objective measurements (Kmax increase ≥1.0 diopter, pachymetry decrease ≥15 microns over 12 months). If denied, Virginia's Bureau of Insurance

How to Get Ibrance (Palbociclib) Covered by Humana in Florida: Complete Decision Tree and Appeals Guide

Answer Box: Getting Ibrance (Palbociclib) Covered by Humana in Florida You'll likely qualify if you have HR+/HER2- advanced breast cancer with proper pathology documentation. Humana requires prior authorization for Ibrance, typically processed within 2-3 business days with complete documentation. Your first step today: Gather your pathology reports

How to Get Eloctate Covered by Humana in Texas: Complete Prior Authorization Guide with Forms and Appeals

Answer Box: Getting Eloctate Covered by Humana in Texas Eloctate (efmoroctocog alfa) requires prior authorization from Humana in Texas for all plan types. The fastest path: Have your hematologist submit a PA request with complete clinical documentation via Humana's provider portal or fax to 877-486-2621. Include diagnosis, factor

How to Get Gamifant (Emapalumab-lzsg) Covered by Humana in Virginia: Complete Guide with Forms and Appeal Process

Quick Answer: Getting Gamifant (Emapalumab-lzsg) Covered by Humana in Virginia Fastest path to approval: Have your hematologist submit a prior authorization request to Humana with documented HLH-2004 criteria (5 of 8 required), genetic testing or family history, and evidence of conventional therapy failure. Submit via fax to 502-508-9300 with complete