Topic

Humana

A collection of 128 issues

Renewing Idelvion (Albutrepenonacog Alfa) Approval with Humana in Florida: 2025 Timeline and Appeals Guide

Answer Box: Renewing Idelvion with Humana in Florida Humana Medicare Advantage requires prior authorization renewal for Idelvion every 6-12 months. Start your renewal 30-45 days before expiration to avoid coverage gaps. Submit updated clinical documentation through the Humana Provider Portal including recent factor IX levels, bleeding event logs, and physician

Myths vs. Facts: Getting Rylaze (Asparaginase Erwinia Chrysanthemi) Covered by Humana in Georgia

Answer Box: Getting Rylaze Covered by Humana in Georgia Quick Facts: Rylaze requires prior authorization from Humana for ALL/LBL patients with documented Grade 2-4 hypersensitivity to E. coli asparaginase (Oncaspar). Fastest path: 1) Gather hypersensitivity documentation, 2) Submit PA request through Humana provider portal with clinical notes, 3) If

Coding That Helps Get Darzalex/Darzalex Faspro (Daratumumab) Approved by Humana in Michigan: ICD-10, J-Codes & Appeal Guide

Answer Box: Getting Darzalex/Darzalex Faspro Covered by Humana in Michigan Humana requires prior authorization for Darzalex (daratumumab) in 2024. The fastest path to approval: ensure proper ICD-10 coding (C90.00-C90.02 for multiple myeloma, E85.4/E85.9 for AL amyloidosis), use correct HCPCS code J9144 for Faspro billing,

How to Get StrataGraft Covered by Humana in Illinois: Coding, Appeals & Prior Authorization Guide

Answer Box: StrataGraft requires prior authorization from Humana Medicare Advantage in Illinois, billed as medical benefit using HCPCS J7353. Submit PA request with ICD-10 burn codes (T21-T31), wound measurements, and clinical documentation. If denied, file internal appeal within 60 days, then Illinois external review within 4 months. Start today: gather

How to Get Adynovate Approved by Humana in Texas: Complete Prior Authorization Guide

Answer Box: Adynovate (bdanocog alfa pegol) requires prior authorization from Humana Medicare plans in Texas. The fastest path: (1) Have your hematologist submit the "Request for Medicare Prescription Drug Coverage Determination" form via fax to 877-486-2621 with hemophilia A diagnosis, factor VIII level <1-5%, and bleeding history

How to Get Elelyso (Taliglucerase Alfa) Covered by Humana in Washington: Complete Guide with Appeals Process

Quick Answer: Getting Elelyso Covered by Humana in Washington Elelyso (taliglucerase alfa) requires prior authorization from Humana. You'll need: confirmed Type 1 Gaucher disease diagnosis (enzyme deficiency + genetic testing), specialist prescriber (hematologist/endocrinologist), and clinical documentation showing medical necessity. If denied, Washington offers strong appeal rights including binding

Myths vs. Facts: Getting Vanflyta (Quizartinib) Covered by Humana in Georgia

Answer Box: Vanflyta Coverage by Humana in Georgia Myth-busting reality: Vanflyta (quizartinib) coverage by Humana requires prior authorization with FLT3-ITD mutation testing, EKG monitoring protocols, and often step therapy through midostaurin first. Most denials stem from missing documentation, not automatic rejections. Fastest path: Submit complete prior authorization with FLT3-ITD test

How to Get Pomalyst (Pomalidomide) Covered by Humana in Michigan: Prior Authorization Guide & Appeal Templates

Answer Box: Getting Pomalyst (Pomalidomide) Covered by Humana in Michigan Fastest path to approval: Submit prior authorization with documented failure of both lenalidomide and a proteasome inhibitor, plus oncologist letter confirming medical necessity. If denied, file internal appeal within 65 days, then request Michigan DIFS external review within 127 days.

How to Get Onivyde (Irinotecan Liposome) Covered by Humana in Washington: Prior Authorization, Appeals & Network Requirements

Answer Box: Getting Onivyde Covered by Humana in Washington Humana covers Onivyde (irinotecan liposome) in Washington, but requires prior authorization (PA) for all regimens. The NALIRIFOX combination (Onivyde + oxaliplatin + 5-FU + leucovorin) is FDA-approved for first-line metastatic pancreatic cancer as of February 2024. Fastest path to approval: 1. Submit PA request

Do You Qualify for Cystadane Coverage by Humana in Texas? Decision Tree & Next Steps

Answer Box: If you have confirmed homocystinuria with elevated homocysteine (>50 µmol/L) and documented CBS, MTHFR, or cobalamin deficiency, you likely qualify for Cystadane coverage through Humana in Texas. The fastest path: have your doctor submit prior authorization with genetic testing results, plasma homocysteine levels, and vitamin B6/