Topic

Humana

A collection of 129 issues

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/

Get Mepsevii Covered by Humana in Pennsylvania: Prior Authorization Requirements and Appeal Process

Quick Answer: Humana requires prior authorization for Mepsevii (vestronidase alfa-vjbk) in Pennsylvania. Submit PA request with MPS VII diagnosis confirmation, weight-based dosing justification, and specialist documentation. If denied, file internal appeal within 60 days, then Pennsylvania external review within 4 months. Start by contacting your prescriber to initiate the PA

Work With Your Doctor to Get Elelyso (taliglucerase alfa) Approved by Humana in Pennsylvania: Complete Provider Collaboration Guide

Answer Box: Get Elelyso (taliglucerase alfa) Covered by Humana in Pennsylvania Humana requires prior authorization for Elelyso (taliglucerase alfa) in Pennsylvania. Your physician must submit documentation proving confirmed Type 1 Gaucher disease diagnosis (enzyme testing + genetics), medical necessity, and consideration of formulary alternatives. If denied, you can appeal through Humana&

Get Filsuvez Covered by Humana in Georgia: Prior Authorization Requirements and Appeals Process

Answer Box: Quick Path to Approval To get Filsuvez covered by Humana in Georgia: Submit prior authorization with genetic EB confirmation (COL7A1 for dystrophic, LAMA3/LAMB3/LAMC2 for junctional), documented failure of standard wound care, and wound measurements showing 10-50 cm² partial-thickness wounds present ≥3 weeks. Must be prescribed by

Work With Your Doctor to Get Sumavel DosePro Covered by Humana in New York: Complete Prior Authorization Guide

Answer Box: Getting Sumavel DosePro Covered by Humana in New York Note: Sumavel DosePro has been discontinued in the U.S. However, if you have a prescription or need coverage for similar needle-free sumatriptan delivery systems, Humana Medicare Advantage requires step therapy with oral triptans first. You'll need

How to Get Carbaglu (Carglumic Acid) Covered by Humana in Virginia: Complete Appeals Guide

Answer Box: Getting Carbaglu Covered by Humana in Virginia Humana requires prior authorization for Carbaglu (carglumic acid) for NAGS deficiency treatment. In Virginia, you have strong appeal rights through the State Corporation Commission Bureau of Insurance. First steps: 1) Gather genetic confirmation of NAGS deficiency and elevated ammonia labs, 2)

Get Fabrazyme (Agalsidase Beta) Covered by Humana in Virginia: Complete Guide to Prior Authorization, Appeals, and Success Strategies

Quick Answer: To get Fabrazyme (agalsidase beta) covered by Humana in Virginia, you need prior authorization with genetic confirmation of Fabry disease, a specialist prescription, and complete clinical documentation. Submit through Humana's provider portal with HCPCS code J0180. If denied, you have 65 days to appeal, followed by

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

Answer Box: Getting Tepezza Covered by Humana in Pennsylvania Tepezza (teprotumumab) requires prior authorization from Humana for thyroid eye disease (TED) treatment. To get approved: (1) Your ophthalmologist or endocrinologist must document active, moderate-to-severe TED with Clinical Activity Score ≥3 and proptosis measurements, (2) Submit prior authorization through Humana'

Get Hemlibra (Emicizumab) Covered by Humana in New York: Complete Guide to Prior Authorization and Appeals

Answer Box: Quick Path to Hemlibra Coverage Hemlibra (emicizumab) requires prior authorization from Humana Medicare plans. To get approved in New York: 1) Have your hematologist submit a PA request with hemophilia A diagnosis, FVIII inhibitor test results, and treatment history to Humana at 877-486-2621. 2) If denied, request a

How to Get Mycapssa (Octreotide Oral) Covered by Humana in Washington: Complete Prior Authorization Guide

Answer Box: Getting Mycapssa Covered by Humana in Washington Mycapssa (oral octreotide) requires prior authorization from Humana and typically needs documentation of prior response to injectable octreotide or lanreotide for acromegaly. Here's the fastest path: 1. Gather documentation: Confirmed acromegaly diagnosis (elevated IGF-1), prior injectable SSA therapy records,