Topic

Texas

A collection of 233 issues

How to Get Waylivra (Volanesorsen) Covered by Blue Cross Blue Shield Texas: Prior Authorization Guide, Appeals Process, and State Protections

Answer Box: Getting Waylivra Covered in Texas Waylivra (volanesorsen) requires formulary exception and prior authorization from Blue Cross Blue Shield of Texas since it's not FDA-approved in the US. For familial chylomicronemia syndrome (FCS), you'll need confirmed diagnosis, documented failure of standard triglyceride therapies, and specialist

Get Alprolix Covered by Humana in Texas: Prior Authorization Guide with Appeal Templates

Quick Answer: Getting Alprolix Covered by Humana in Texas Alprolix requires prior authorization from Humana and typically faces step therapy requirements. Your fastest path: 1) Have your hematologist submit a PA request with bleeding history and failed preferred alternatives, 2) Route prescriptions through CenterWell Specialty Pharmacy, 3) If denied, you

Renewing Ruconest (C1 Esterase Inhibitor) Approval with Humana in Texas: Complete Guide to Documentation and Timelines

Answer Box: Renewing Ruconest with Humana in Texas Start your renewal 30 days before expiration. Humana requires updated clinical documentation showing ongoing medical necessity for hereditary angioedema (HAE), including attack frequency reduction and treatment response. Submit via Humana's provider portal with prescriber attestation, recent clinical notes, and evidence

How to Get Firdapse (Amifampridine) Covered by Aetna CVS Health in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Firdapse Covered by Aetna CVS Health in Texas Aetna CVS Health requires prior authorization for Firdapse (amifampridine) in Texas. To get approved, you need: (1) confirmed LEMS diagnosis with EMG showing ≥60% increment or positive VGCC antibodies, (2) prescription from a neurologist/neuromuscular specialist, and (3) documentation

The Requirements Checklist to Get Aldurazyme (Laronidase) Covered by Cigna in Texas

Quick Answer: Getting Aldurazyme Covered by Cigna in Texas Eligibility: Patients with confirmed mucopolysaccharidosis I (MPS I) via genetic/biochemical testing. Fastest approval path: Submit complete prior authorization with genetic confirmation, baseline assessments, and specialist attestation through Cigna's provider portal or Express Scripts/Accredo. First step today: Contact

How to Get Qinlock (ripretinib) Covered by Cigna in Texas: Prior Authorization Guide & Appeal Scripts

Quick Answer: Getting Qinlock (ripretinib) Covered by Cigna in Texas Cigna covers Qinlock (ripretinib) for fourth-line GIST treatment with prior authorization. You must document failure of three prior tyrosine kinase inhibitors: imatinib, sunitinib, and regorafenib. First step: Have your oncologist submit a prior authorization request with complete treatment history. If

UnitedHealthcare's Coverage Criteria for Nucala (mepolizumab) in Texas: What Counts as "Medically Necessary"?

Answer Box: Getting Nucala Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Nucala (mepolizumab) with specific criteria: eosinophil count ≥150 cells/µL (or ≥300 cells/µL in past year) for severe asthma, documented failure of high-dose inhaled therapy, and specialist involvement. Fastest path: Submit PA through UnitedHealthcare Provider

How to Get Isturisa (Osilodrostat) Covered by Cigna in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Isturisa Covered by Cigna in Texas Cigna requires prior authorization for Isturisa (osilodrostat) with specific clinical documentation. The fastest path to approval requires: (1) endocrinologist prescription with confirmed Cushing's disease diagnosis, (2) documented surgical contraindication or failure, and (3) abnormal cortisol test results (UFC, salivary

Getting Revcovi (Elapegademase) Covered by Humana in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Revcovi Coverage with Humana in Texas Getting Revcovi (elapegademase) covered by Humana requires prior authorization with documented ADA-SCID diagnosis and specialist oversight. Submit through Humana's provider portal with ADA enzyme testing (<1% normal activity) or genetic confirmation, plus a medical necessity letter

Work With Your Doctor to Get Opdivo (Nivolumab) Covered by Blue Cross Blue Shield in Texas: Complete PA Guide and Appeal Process

Answer Box: Getting Opdivo Covered by Blue Cross Blue Shield in Texas Quick Path to Approval: Blue Cross Blue Shield of Texas requires prior authorization for Opdivo (nivolumab). Work closely with your oncologist to submit comprehensive documentation including diagnosis, staging, biomarker results, and prior therapy history. If denied, Texas law