Topic

Prolastin-C (alpha1-proteinase inhibitor)

A collection of 25 issues

Aetna (CVS Health) Coverage Criteria for Prolastin-C in Florida: What Counts as "Medically Necessary"?

Answer Box To get Prolastin-C covered by Aetna (CVS Health) in Florida, you need: 1) Confirmed severe AAT deficiency (Pi*ZZ genotype + serum AAT <57 mg/dL), 2) Post-bronchodilator FEV₁ between 25-80% predicted, and 3) Documentation of emphysema/COPD due to AAT deficiency. Submit prior authorization using Aetna'

How to Get Prolastin-C (Alpha1-Proteinase Inhibitor) Covered by Aetna CVS Health in Michigan: Complete Coding, Prior Authorization & Appeals Guide

Answer Box: Getting Prolastin-C Covered by Aetna CVS Health in Michigan Prolastin-C requires prior authorization from Aetna CVS Health with specific coding and documentation. Use ICD-10 code E88.01 (alpha-1 antitrypsin deficiency) with J43.9 (emphysema), HCPCS code J0256 (10mg units), and NDC 13533-0700-xx series. Submit PA forms to 888-267-3277

Renewing Prolastin-C Coverage with Cigna in Pennsylvania: Complete 2025 Guide to Authorization, Appeals, and Timing

Answer Box: Fastest Path to Prolastin-C Renewal Cigna requires annual reauthorization for Prolastin-C in Pennsylvania. Start your renewal 60-90 days before expiration by gathering updated spirometry (within 6 months), recent clinical notes from your pulmonologist, and documentation of continued clinical benefit. Submit via your provider's Cigna portal or

How to Get Prolastin-C (Alpha1-Proteinase Inhibitor) Covered by Cigna in Michigan: Complete PA Guide and Appeals Process

Answer Box: Getting Prolastin-C Covered by Cigna in Michigan Cigna requires prior authorization for Prolastin-C (alpha1-proteinase inhibitor) with step therapy preference over Zemaira. Key requirements: severe AAT deficiency (genotype Pi*ZZ or equivalent), serum AAT <80 mg/dL, emphysema documentation, and non-smoker status. First step today: Have your pulmonologist

Myths vs. Facts: Getting Prolastin-C Covered by UnitedHealthcare in Florida (2025 Guide)

Answer Box: Prolastin-C Coverage by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Prolastin-C with documented severe alpha-1 antitrypsin deficiency (Pi*ZZ genotype), emphysema evidence, and step therapy trial of preferred alternatives like Aralast NP or Glassia unless contraindicated. Coverage falls under medical benefit with site-of-care preference for home infusion

Do You Qualify for Prolastin-C Coverage by Blue Cross Blue Shield in Georgia? Decision Tree & Next Steps

Answer Box: Getting Prolastin-C Covered in Georgia Most likely to get approved: Adults with confirmed severe alpha-1 antitrypsin deficiency (Pi*ZZ genotype, AAT level ≤11 µM), emphysema on imaging, non-smoking status, and documented optimal COPD therapy. Blue Cross Blue Shield Georgia typically requires prior authorization through their specialty pharmacy program.

How to Get Prolastin-C Covered by Aetna in New York: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Prolastin-C Covered by Aetna in New York Prolastin-C requires prior authorization from Aetna in New York. To get approved: (1) Have your pulmonologist complete Aetna's Alpha-1 Proteinase Inhibitors PA form with severe genotype (Pi*ZZ), FEV1 30-65% predicted, and non-smoking status, (2) Submit via phone

Renewing Prolastin-C (Alpha1-Proteinase Inhibitor) Approval with Aetna CVS Health in Washington: Timeline, Documentation & Appeal Guide

Answer Box: Renewing Prolastin-C Coverage with Aetna CVS Health Start your renewal 90 days early. Aetna typically approves Prolastin-C for 3-6 months initially, then 12-month renewals. You'll need updated AAT levels, FEV1 results, and proof of clinical benefit. Submit 60 days before expiration through CVS Caremark or your

Work With Your Doctor to Get Prolastin-C Approved by UnitedHealthcare in New Jersey: Provider Partnership Guide

Answer Box: Your Partnership Path to Prolastin-C Approval Getting Prolastin-C covered by UnitedHealthcare in New Jersey requires strong collaboration with your doctor. You need documented severe alpha-1 antitrypsin deficiency (Pi*ZZ genotype), emphysema evidence, and failed step therapy alternatives. Your fastest path: (1) Schedule a pre-authorization visit to gather all

How to Get Prolastin-C Covered by Humana in Florida: Appeals, Timelines, and Renewal Guide

Answer Box: Getting Prolastin-C Covered by Humana in Florida Eligibility: Prolastin-C requires prior authorization from Humana with documented severe alpha-1 antitrypsin deficiency (typically Pi*ZZ genotype), emphysema, and failure of preferred agent Aralast. Fastest path: Submit complete PA request with genotype results, pulmonary function tests, and specialist letter through Humana&