Topic

Humana

A collection of 599 issues

How to Get Orfadin (nitisinone) Covered by Humana in New York: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Orfadin (nitisinone) Covered by Humana in New York Humana requires prior authorization for Orfadin (nitisinone) to treat hereditary tyrosinemia type 1 (HT-1). Your fastest path to approval: Gather confirmed HT-1 diagnosis (elevated succinylacetone levels, genetic testing), obtain a medical necessity letter from your prescriber, and submit through

Getting Soliris (Eculizumab) Approved by Humana in New York: Complete Coding and Appeal Guide

Quick Answer: Your Path to Approval Soliris (eculizumab) is covered under Humana Medicare Part B when medically necessary for FDA-approved conditions. Key requirements: proper ICD-10 diagnosis coding, proof of meningococcal vaccination, and specialist documentation. Start today: Have your provider submit a prior authorization using HCPCS code J1299 (2 mg/unit)

How to Get Palynziq (pegvaliase-pqpz) Covered by Humana in Virginia: Forms, Appeals, and Provider Resources

Quick Answer: Getting Palynziq (pegvaliase-pqpz) Covered by Humana in Virginia Palynziq requires prior authorization from Humana for all Virginia members with PKU whose phenylalanine levels exceed 600 µmol/L. Your fastest path to approval: 1) Have your prescriber complete Humana's prior authorization form and fax to 1-888-447-3430, 2)

Coding That Helps Get Firdapse (amifampridine) Covered by Humana in Pennsylvania: ICD-10, NDC, and Billing Requirements

Answer Box: Getting Firdapse (amifampridine) Covered by Humana in Pennsylvania Quick approval path: Use ICD-10 codes G70.80 or G70.81 for Lambert-Eaton myasthenic syndrome (LEMS), bill with the correct Firdapse NDC (49948-100-01 for 10mg tablets), and submit via Medicare Part D pharmacy benefit—not Part B. Humana requires prior

How to Get Duopa Covered by Humana in Florida: Complete Guide to Prior Authorization, Appeals, and State Protections

Quick Answer: Getting Duopa Covered by Humana in Florida Duopa requires prior authorization from Humana Medicare Advantage plans in Florida. Your fastest path to approval: (1) Have your neurologist submit a complete PA request through Humana's provider portal with documented motor fluctuations (≥3 hours "OFF" time

How to Get Oxbryta (Voxelotor) Covered by Humana in Texas: Appeals Process and Provider Partnership Guide

Answer Box: Getting Oxbryta (Voxelotor) Covered by Humana in Texas Important Update: Oxbryta (voxelotor) was withdrawn from the U.S. market in 2024 after the FDA requested its removal following confirmatory evidence review. Claims are now typically denied due to loss of FDA approval. However, patients currently on therapy may

Renewing Tremfya (Guselkumab) Coverage with Humana in New York: 2025 Requirements and Timeline

Answer Box: To renew Tremfya (guselkumab) coverage with Humana in New York, submit your renewal request with updated clinical documentation 30-60 days before your current authorization expires. Include PASI scores showing continued response, adherence documentation, and any new clinical notes. Humana reviews renewals within 72 hours (standard) or 24 hours

How to Get Kanuma (Sebelipase Alfa) Covered by Humana in New Jersey: Requirements Checklist and Appeals Guide

Answer Box: Fastest Path to Approval Getting Kanuma (sebelipase alfa) covered by Humana in New Jersey requires prior authorization with confirmed LAL-D diagnosis through enzyme testing and genetic analysis. Submit your PA request through Humana's provider portal with complete diagnostic documentation, medical necessity letter, and evidence of supportive

How to Get Defitelio (Defibrotide) Covered by Humana in Illinois: PA Requirements, Appeals, and Cost Assistance

Quick Answer: Defitelio (defibrotide) requires prior authorization from Humana Medicare Advantage plans in Illinois for its FDA-approved use treating hepatic veno-occlusive disease (VOD/SOS) after stem cell transplantation. Your prescriber must submit documentation proving organ dysfunction and medical necessity. If denied, you have 65 days to appeal and can request

How to Get Xospata (Gilteritinib) Covered by Humana in North Carolina: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Xospata (Gilteritinib) Covered by Humana in North Carolina Xospata requires prior authorization from Humana and is placed on the specialty drug tier. For approval, you need: (1) confirmed FLT3 mutation test results from an FDA-approved assay, (2) documented relapsed/refractory AML diagnosis, and (3) prior therapy history.