Topic

Texas

A collection of 388 issues

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,

How to Get Onpattro (Patisiran) Covered by Humana in Texas: Complete Timeline & Appeals Guide

Answer Box: Getting Onpattro Covered by Humana in Texas Humana requires prior authorization for Onpattro (patisiran) in Texas with a 7-day standard decision timeline (72 hours if expedited). Key requirements: genetic confirmation of TTR variant, neurologist evaluation for hATTR polyneuropathy, and baseline functional assessments (mNIS+7, 6MWT). Submit electronically via

How Long Does It Take to Get Orladeyo (berotralstat) Approved by Aetna CVS Health in Texas? Complete Timeline Guide

Quick Answer: Orladeyo Approval Timeline with Aetna CVS Health in Texas Standard timeline: 2-30 days for complete submissions. Aetna CVS Health requires prior authorization for Orladeyo (berotralstat) with documented HAE diagnosis, step therapy failures, and specialist involvement. Fastest path: Submit electronically through Availity portal with complete documentation from an allergist/

Tegsedi (Inotersen) Approval with Blue Cross Blue Shield of Texas: Complete Guide with Forms and Appeal Scripts

Quick Answer: Blue Cross Blue Shield of Texas requires prior authorization, REMS program enrollment, and documented step therapy failure for Tegsedi (inotersen) coverage. Your doctor submits the PA request through the provider portal with genetic testing, treatment history, and REMS enrollment proof. If denied, you have 60 days to appeal

The Requirements Checklist to Get Uplizna (inebilizumab) Covered by Blue Cross Blue Shield in Texas: Complete Prior Authorization Guide

Answer Box: Getting Uplizna Covered by BCBS Texas Uplizna (inebilizumab) requires prior authorization from Blue Cross Blue Shield of Texas for both NMOSD and IgG4-RD. The fastest path to approval: (1) Confirm AQP4-IgG positive status via cell-based assay for NMOSD or histologic confirmation for IgG4-RD, (2) Document failed conventional therapies

How Long Does It Take to Get Hetlioz LQ Approved by UnitedHealthcare in Texas? Complete Timeline Guide

Answer Box: Getting Hetlioz LQ Approved by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Hetlioz LQ (tasimelteon oral suspension) in Texas, with standard approval taking 72 hours for complete submissions. For pediatric Smith-Magenis syndrome patients aged 3-15, you'll need genetic confirmation, documented sleep disturbances, and proof of

How to Get Helixate (Factor VIII) Covered by Cigna in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Helixate Covered by Cigna in Texas Helixate (recombinant Factor VIII) requires prior authorization from Cigna and is typically non-formulary, requiring specialty pharmacy dispensing through Accredo. Your fastest path to approval: 1) Have your hematologist submit a comprehensive PA request with hemophilia A diagnosis, Factor VIII levels, and

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

Answer Box: Getting Naglazyme (Galsulfase) Covered by Cigna in Texas Fast Path: Naglazyme requires prior authorization from Cigna. Submit via CoverMyMeds portal or Cigna provider portal with confirmed MPS VI diagnosis, enzyme/genetic testing, and medical necessity letter. If denied, file internal appeal within 180 days, then Texas Independent Review

How to Get Entresto (Sacubitril/Valsartan) Covered by UnitedHealthcare in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Entresto Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Entresto (sacubitril/valsartan) with specific heart failure criteria and ACE inhibitor/ARB trial documentation. Your fastest path to approval: 1. Gather required documents: Recent echocardiogram showing LVEF ≤40%, heart failure diagnosis with ICD-10 code, and documentation