Topic

Humana

A collection of 1018 issues

Myths vs. Facts: Getting Uptravi (Selexipag) Covered by Humana in North Carolina

Answer Box Getting Uptravi (selexipag) covered by Humana in North Carolina requires prior authorization with specific WHO Group I PAH documentation. Key requirements: right heart catheterization showing mPAP ≥25 mmHg and PCWP ≤15 mmHg, trials of two other PAH drug classes, and WHO Functional Class II-III status. If denied, file

Resources to Get Arcalyst (Rilonacept) Approved by Humana in Illinois: Complete Forms, Portals & Appeals Guide

How to Get Arcalyst (Rilonacept) Covered by Humana in Illinois Arcalyst (rilonacept) requires prior authorization from Humana as a specialty drug. Your fastest path: verify your plan's formulary status, submit a complete PA request with medical necessity documentation, and use CenterWell Specialty Pharmacy for fulfillment. Start today by

How to Get Strimvelis Gene Therapy Covered by Humana in Michigan: Coding, Appeals, and Authorization Guide

Answer Box: Getting Strimvelis Covered by Humana in Michigan Strimvelis requires prior authorization from Humana using ICD-10 code D81.1 (ADA-deficient SCID) and unclassified HCPCS codes C9399 or J3590 since it lacks a specific J-code. Submit PA requests to Humana National Transplant Network at 866-421-5663 or fax 502-508-9300. If denied,

How to Get Tepezza (teprotumumab) Covered by Humana in Georgia: Complete Prior Authorization and Appeals Guide

Quick Answer: Humana requires prior authorization for Tepezza (teprotumumab) for thyroid eye disease in Georgia. Submit your PA request through CoverMyMeds or Humana's provider portal with complete TED documentation: CAS score ≥4, thyroid labs within 30 days, prior therapy history, and ophthalmology notes. If denied, appeal within 65

How to Get Hetlioz LQ (Tasimelteon Oral Suspension) Covered by Humana in Pennsylvania: Prior Authorization Guide with Appeal Templates

Quick Answer: Hetlioz LQ (tasimelteon oral suspension) requires prior authorization for Humana plans in Pennsylvania. You'll need confirmed Smith-Magenis syndrome diagnosis with genetic testing, documented sleep disturbances, and evidence of failed alternatives. Submit via Humana's provider portal with complete documentation. If denied, Pennsylvania's new

Getting Translarna (Ataluren) Covered by Humana in Virginia: Prior Authorization Guide and Appeal Process

Answer Box: How to Get Translarna (Ataluren) Covered by Humana in Virginia Translarna (ataluren) requires prior authorization from Humana and is typically not on standard formularies. Your fastest path to coverage: 1. Confirm genetic testing shows nonsense mutation Duchenne muscular dystrophy (nmDMD) 2. Document corticosteroid trial/failure to meet step

How to Get Qalsody (tofersen) Covered by Humana in Virginia: Complete Prior Authorization Guide

Answer Box: Getting Qalsody (tofersen) Covered by Humana in Virginia Yes, Humana covers Qalsody for SOD1-ALS patients in Virginia under Medicare Part B. Following CMS's December 2024 directive, Medicare Advantage plans must cover Qalsody when medically necessary. Your fastest path to approval: Have your neurologist submit prior authorization

How to Get Elelyso (taliglucerase alfa) Covered by Humana in Ohio: Complete Prior Authorization Guide

Answer Box: Getting Elelyso (taliglucerase alfa) Covered by Humana in Ohio Humana requires prior authorization for Elelyso (taliglucerase alfa) across all Ohio plans in 2025. To get approval: (1) Have your Gaucher specialist submit a PA request with confirmed Type 1 Gaucher disease diagnosis, enzyme deficiency labs, and clinical severity

How to Get Revlimid (Lenalidomide) Covered by Humana in California: Timeline, Appeals, and State Protections

Quick Answer: Your Path to Revlimid Coverage Humana requires prior authorization for Revlimid (lenalidomide) in California, with standard decisions within 7 days and expedited reviews in 72 hours for urgent cases. Start by ensuring REMS compliance (prescriber and patient enrollment), then submit medical necessity documentation through your oncologist. If denied,

Myths vs. Facts: Getting Exondys 51 (eteplirsen) Covered by Humana in Florida

Answer Box: To get Exondys 51 (eteplirsen) covered by Humana in Florida, you need: 1) Genetic testing confirming an exon 51-amenable DMD mutation, 2) A neuromuscular specialist's prescription with medical necessity documentation, and 3) Prior authorization submission via Humana's provider portal. Standard PA decisions take 72