Topic

Texas

A collection of 386 issues

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

Quick Answer: Getting Givlaari (givosiran) Covered by Aetna (CVS Health) in Texas Givlaari requires prior authorization from Aetna (CVS Health) in Texas. You'll need documented acute hepatic porphyria with elevated ALA/PBG levels, evidence of ≥2 qualifying attacks in 6 months or hemin use, and specialist involvement. Submit

How to Get Bavencio (Avelumab) Covered by Humana in Texas: Complete Prior Authorization Guide

Quick Answer: Getting Bavencio Covered by Humana in Texas Bavencio (avelumab) requires prior authorization from all Humana plans in Texas. Your oncologist submits documentation proving FDA-approved indication (Merkel cell carcinoma or urothelial carcinoma maintenance), prior platinum therapy history, and ECOG performance status 0-2. Standard approvals take 15 business days; expedited

How to Get Ruconest (C1 Esterase Inhibitor) Covered by Aetna CVS Health in Texas: Complete Guide with Forms and Appeal Process

Quick Answer: Getting Ruconest Covered by Aetna CVS Health in Texas To get Ruconest (C1 esterase inhibitor [recombinant]) covered by Aetna CVS Health in Texas, you'll need prior authorization requiring HAE diagnosis confirmation, prescriber specialty verification (immunologist/allergist), and documentation that you're 13+ years old. Submit

How to Get Ofev (Nintedanib) Covered by Blue Cross Blue Shield in Texas: Prior Authorization Guide and Appeal Process

Answer Box: Getting Ofev Covered by Blue Cross Blue Shield in Texas Ofev (nintedanib) is covered on Blue Cross Blue Shield of Texas formularies but requires prior authorization for idiopathic pulmonary fibrosis and related conditions. To get approval: (1) Have your pulmonologist submit a PA request with HRCT results, pulmonary

The Requirements Checklist to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Blue Cross Blue Shield of Texas: Forms, Appeals, and PA Guide

Answer Box: Getting Enhertu Covered by Blue Cross Blue Shield of Texas Eligibility: Patients with HER2-positive or HER2-low breast cancer, HER2-positive gastric cancer, or HER2-mutant NSCLC who meet FDA labeling criteria. Fastest path: Submit prior authorization with complete HER2 testing, medical necessity letter, and ILD monitoring plan through BCBS Texas

The Requirements Checklist to Get Jaypirca (Pirtobrutinib) Covered by Cigna in Texas: Complete Prior Authorization Guide

Answer Box: Getting Jaypirca (Pirtobrutinib) Covered by Cigna in Texas Eligibility: Adults 18+ with relapsed/refractory mantle cell lymphoma (after BTK inhibitor) or CLL/SLL (after BTK inhibitor + BCL-2 inhibitor). Fastest path: Submit prior authorization through CoverMyMeds or call Cigna at 1-800-882-4462 with complete treatment history. First step today: Gather

If Juxtapid (lomitapide) Isn't Approved by Cigna in Texas: Formulary Alternatives & Exception Paths

Quick Answer: Your Options When Cigna Denies Juxtapid (lomitapide) in Texas If Cigna denies Juxtapid (lomitapide) for homozygous familial hypercholesterolemia (HoFH), you have three main paths: try formulary alternatives first (like PCSK9 inhibitors), request a formulary exception with strong medical necessity documentation, or appeal the denial through Texas's

How to Get Rezlidhia (olutasidenib) Covered by Cigna in Texas: Appeals Guide with State Protections

Answer Box: Getting Rezlidhia (olutasidenib) Covered by Cigna in Texas Eligibility: Adults with relapsed/refractory AML and confirmed IDH1 mutation via FDA-approved diagnostic test, prescribed by a board-certified oncologist. Fastest Path: Your oncologist submits complete prior authorization to Cigna with IDH1 mutation results (FDA-approved test), medical necessity letter citing NCCN

Myths vs. Facts: Getting Imbruvica (ibrutinib) Covered by Cigna in Texas

Answer Box: Cigna Imbruvica Coverage in Texas Cigna requires prior authorization for Imbruvica (ibrutinib) with mandatory step therapy—you must try acalabrutinib or zanubrutinib first unless contraindicated. Submit PA through Express Scripts/Accredo with complete diagnosis documentation and prior BTK inhibitor trial records. If denied, file internal appeal within 180

Getting Lamzede (Velmanase Alfa-tycv) Covered by Cigna in Texas: Prior Authorization, Appeals, and Alternative Options

Answer Box: Getting Lamzede Covered by Cigna in Texas Lamzede requires prior authorization from Cigna. Your fastest path: Have your specialist submit a PA request with confirmed alpha-mannosidosis diagnosis (enzyme deficiency + MAN2B1 gene variants), failed alternative treatments, and medical necessity documentation. If denied, you have 180 days to appeal internally,