Topic

Texas

A collection of 390 issues

How to Get Oxbryta (Voxelotor) Covered by Humana in Texas: Appeals Process and Provider Partnership Guide

Answer Box: Getting Oxbryta (Voxelotor) Covered by Humana in Texas Important Update: Oxbryta (voxelotor) was withdrawn from the U.S. market in 2024 after the FDA requested its removal following confirmatory evidence review. Claims are now typically denied due to loss of FDA approval. However, patients currently on therapy may

Work With Your Doctor to Get Strensiq (asfotase alfa) Approved by Blue Cross Blue Shield in Texas: Complete Provider Collaboration Guide

Answer Box: Getting Strensiq Approved in Texas Blue Cross Blue Shield of Texas requires prior authorization for Strensiq (asfotase alfa) with strict pediatric-onset hypophosphatasia criteria. To get approved: (1) Confirm your doctor has genetic testing (ALPL mutation) and low alkaline phosphatase labs, (2) Submit comprehensive medical records showing onset before

Myths vs. Facts: Getting Exondys 51 (Eteplirsen) Covered by UnitedHealthcare in Texas - Appeals Guide

Quick Answer: Your Path to Exondys 51 Coverage in Texas Myth: If your neurologist prescribes Exondys 51, UnitedHealthcare automatically covers it. Fact: Prior authorization is mandatory, requiring genetic proof of exon 51-amenable DMD mutation, specialist prescriber credentials, and functional assessments (6-minute walk test ≥300 meters or equivalent). Most denials stem

How to Get Tepezza (Teprotumumab) Covered by Blue Cross Blue Shield in Texas: Complete Prior Authorization Guide

Quick Answer: Getting Tepezza Covered by Blue Cross Blue Shield of Texas Tepezza (teprotumumab) requires prior authorization from Blue Cross Blue Shield of Texas (BCBSTX) for thyroid eye disease coverage. The fastest path to approval: (1) Confirm your plan covers medical benefit drugs under HCPCS J3241, (2) gather clinical documentation

How to Get Kalydeco (ivacaftor) Covered by Blue Cross Blue Shield of Texas: Prior Authorization Guide & Appeal Scripts

Answer Box: Getting Kalydeco Covered by Blue Cross Blue Shield of Texas Kalydeco (ivacaftor) is covered by Blue Cross Blue Shield of Texas with prior authorization, quantity limits (60 tablets per 30 days), and specialty pharmacy requirements. To get approval: (1) Confirm your CFTR mutation is FDA-approved for ivacaftor, (2)

How to Get Rylaze Covered by Aetna CVS Health in Texas: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Rylaze Covered by Aetna CVS Health in Texas Rylaze requires prior authorization from Aetna CVS Health in Texas. You need documented hypersensitivity to E. coli asparaginase, confirmed ALL/LBL diagnosis, and use in multi-agent chemotherapy. Start today: Have your oncologist submit PA with detailed hypersensitivity documentation via

How Long Does It Take to Get Elevidys Approved by Cigna in Texas? Complete Timeline & Requirements

Answer Box: Getting Elevidys Approved by Cigna in Texas Timeline: 5-15 business days for standard prior authorization once complete documentation is submitted. Expedited reviews take 72 hours for urgent cases. Fastest path to approval: 1. Confirm genetic DMD diagnosis and anti-AAVrh74 antibody titer ≤1:400 2. Submit complete PA request

How to Get Turalio (Pexidartinib) Covered by Blue Cross Blue Shield of Texas: Prior Authorization Guide and Appeal Process

Answer Box: Fastest Path to Approval Turalio (pexidartinib) is covered by Blue Cross Blue Shield of Texas for TGCT but requires prior authorization, REMS enrollment, and specialty pharmacy dispensing. The fastest path: (1) Ensure your prescriber and you complete REMS enrollment at TURALIOREMS.com, (2) Have your provider submit a

How to Get Carbaglu (Carglumic Acid) Covered by Cigna in Texas: Decision Tree, Appeals, and Next Steps

Answer Box: Getting Carbaglu Covered by Cigna in Texas Most likely to get approved: Confirmed NAGS deficiency with documented hyperammonemia, prescribed by a metabolic specialist, with protein-restricted diet. Fastest path: Have your metabolic specialist submit prior authorization with genetic testing results, ammonia levels, and treatment plan. First step today: Call

How to Get Uplizna (Inebilizumab) Covered by Cigna in Texas: Complete Guide to Prior Authorization, Appeals, and Approval Strategies

Answer Box: Getting Uplizna (Inebilizumab) Covered by Cigna in Texas Uplizna (inebilizumab) requires prior authorization from Cigna and is typically covered for AQP4-positive NMOSD when prescribed by a neurologist with documented step therapy. Your fastest path: (1) Have your neurologist submit a prior authorization through CoverMyMeds or Cigna's