Topic

Humana

A collection of 1102 issues

How to Get Tavalisse (Fostamatinib) Covered by Humana in Virginia: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Tavalisse Covered by Humana in Virginia Fastest Path: Submit prior authorization through your hematologist with documented ITP diagnosis (ICD-10 D69.3), platelet count <30,000/μL, and evidence of failed corticosteroids plus thrombopoietin receptor agonist therapy. If denied, appeal within 65 days using Humana's

How to Get Spinraza (nusinersen) Covered by Humana in Michigan: Complete Prior Authorization Guide with Appeals Process

Quick Answer: To get Spinraza (nusinersen) covered by Humana in Michigan, you need prior authorization with genetic testing confirming SMA diagnosis, baseline motor function documentation, and neurologist prescription. If denied, you have 65 days for internal appeals, then 127 days for Michigan DIFS external review. Start today: Contact your neurologist

Work With Your Doctor to Get Dojolvi (Triheptanoin) Covered by Humana in Pennsylvania: Complete Provider Partnership Guide

Answer Box: Getting Dojolvi Covered by Humana in Pennsylvania Eligibility: Humana requires molecular confirmation of LC-FAOD via genetic testing, specialist oversight, and discontinuation of other MCT products. Fastest path: Schedule an appointment with your metabolic specialist to gather genetic test results, treatment history, and submit a comprehensive prior authorization with

How to Get Nucala (Mepolizumab) Covered by Humana in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Nucala Covered by Humana in Florida Nucala (mepolizumab) requires prior authorization from Humana with specific criteria: blood eosinophil count ≥150 cells/μL within 6 weeks, severe asthma despite 3+ months of optimized therapy, and age ≥6 years. Fastest approval path: Submit via CoverMyMeds with complete clinical documentation.

How to Get Cerezyme (Imiglucerase) Covered by Humana in North Carolina: Complete Guide with Appeals Process

Answer Box: Getting Cerezyme Covered by Humana in North Carolina Cerezyme (imiglucerase) requires prior authorization from Humana in North Carolina for all plan types. The fastest path to approval: (1) Gather diagnostic confirmation (enzyme deficiency test + GBA1 genetic testing), (2) Submit prior authorization through Humana's provider portal with

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

Quick Answer: Getting Filspari (sparsentan) Covered by Humana in Pennsylvania Filspari (sparsentan) requires prior authorization from Humana in Pennsylvania. First step: Complete REMS enrollment for both prescriber and patient at filsparirems.com. Then submit Humana's PA request with IgA nephropathy biopsy confirmation, UPCR ≥0.5 g/g, and

Work With Your Doctor to Get Elaprase (Idursulfase) Approved by Humana in Florida: Complete Provider Partnership Guide

Quick Answer: Getting Elaprase Approved by Humana in Florida Elaprase (idursulfase) requires prior authorization from Humana Medicare Advantage plans in Florida. Success depends on strong provider partnership and complete documentation. Your fastest path: (1) Schedule a focused appointment to review Hunter syndrome diagnosis and treatment history, (2) Help your doctor

Work With Your Doctor to Get Xenpozyme (olipudase alfa-rpcp) Covered by Humana in New Jersey: Forms, Appeals, and Provider Collaboration Guide

Answer Box: Getting Xenpozyme Covered by Humana in New Jersey Eligibility: Xenpozyme requires genetic confirmation of ASMD (acid sphingomyelinase deficiency) and prior authorization from Humana. Fastest path: Schedule a focused visit with your specialist to gather diagnostic proof (enzyme assay showing <10% normal activity, SMPD1 gene results), document failed

How to Get Trikafta (elexacaftor/tezacaftor/ivacaftor) Covered by Humana in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Trikafta Covered by Humana in California Trikafta requires prior authorization from Humana in California. To get approved: (1) Submit Humana's "Request for Medicare Prescription Drug Coverage Determination" form with CFTR genetic testing results confirming F508del or other responsive mutation, (2) Include CF diagnosis

Getting Aldurazyme (Laronidase) Covered by Humana in Pennsylvania: Complete Prior Authorization Guide

Answer Box: Quick Start Guide Aldurazyme (laronidase) is covered by Humana Medicare Advantage plans in Pennsylvania as a Part B medical benefit, but requires prior authorization. The fastest path to approval: (1) Ensure your specialist submits PA with genetic/enzymatic MPS I confirmation, (2) Include detailed infusion monitoring plan and