Topic

Texas

A collection of 390 issues

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

How to Get Photrexa (Riboflavin) Covered by Blue Cross Blue Shield in Texas: Prior Authorization Guide

Quick Answer: Getting Photrexa Covered by BCBS Texas Blue Cross Blue Shield of Texas (BCBSTX) covers Photrexa (riboflavin ophthalmic solution) with the iLink system for progressive keratoconus when prior authorization requirements are met. You'll need documented disease progression (Kmax increase ≥1.0 diopter), corneal thickness ≥400 microns, and

How to Get Opsumit (Macitentan) Covered by Blue Cross Blue Shield of Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Opsumit Covered by BCBS Texas Blue Cross Blue Shield of Texas requires prior authorization for Opsumit (macitentan). Your doctor must submit a PA request through the BCBS provider portal or Availity, documenting your PAH diagnosis and any failed prior treatments. If denied, you have 180 days to

How to Get Spinraza (nusinersen) Covered by Aetna (CVS Health) in Texas: Complete Prior Authorization Guide with Appeal Scripts

Answer Box: Getting Spinraza Covered by Aetna in Texas Aetna (CVS Health) covers Spinraza (nusinersen) for spinal muscular atrophy but requires prior authorization with genetic confirmation, neurologist attestation, and baseline motor function scores. If denied, Texas patients have strong appeal rights with ~58% success rates when both internal appeals and