Topic

Texas

A collection of 487 issues

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

Answer Box: Getting Translarna (Ataluren) Covered by Cigna in Texas Translarna (ataluren) requires prior authorization from Cigna/Express Scripts and is typically non-formulary, requiring a formulary exception for nonsense mutation Duchenne muscular dystrophy (DMD). The fastest path: 1) Confirm genetic testing shows nonsense mutation, 2) Have your neuromuscular specialist submit

Myths vs. Facts: Getting Filsuvez (Birch Triterpenes) Covered by Blue Cross Blue Shield Texas - Complete Guide

Answer Box: Getting Filsuvez Covered by BCBS Texas Myth: "If my doctor prescribes Filsuvez, BCBS Texas will automatically cover it." Fact: Prior authorization is required for this $27,000+ specialty drug. Success requires genetic confirmation of dystrophic or junctional epidermolysis bullosa, wounds ≥21 days old, and complete documentation.

How to Get Alprolix Covered by Aetna CVS Health in Texas: Complete PA Guide with Appeals Process

Answer Box: Getting Alprolix Covered by Aetna CVS Health in Texas Alprolix is excluded from Aetna's 2024 formularies, requiring a coverage exception for hemophilia B patients in Texas. Submit a prescriber-initiated exception request with documented factor IX deficiency ≤2%, bleeding history, and failed alternatives. Aetna must respond within

How to Get Nourianz (Istradefylline) Covered by Blue Cross Blue Shield of Texas: Prior Authorization, Appeals, and State Protections

Quick Answer: Getting Nourianz Covered in Texas Blue Cross Blue Shield of Texas requires prior authorization for Nourianz (istradefylline), typically with step therapy requirements. Submit your PA request through Availity or call the number on your ID card. If denied, you have 180 days to file an internal appeal, followed

Complete Guide to Getting Evrysdi (Risdiplam) Covered by UnitedHealthcare in Texas: Prior Authorization Requirements and Appeals Process

Quick Answer: Getting Evrysdi Approved by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Evrysdi (risdiplam) with specific criteria: confirmed 5q SMA genetic mutation, baseline motor function assessment, and no concurrent Spinraza therapy. Submit via the UnitedHealthcare Provider Portal with genetic testing results and neurologist consultation. If denied, Texas law

How to Get Dojolvi (Triheptanoin) Covered by UnitedHealthcare in Texas: Complete PA Guide with Appeal Scripts

Answer Box: Getting Dojolvi Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Dojolvi (triheptanoin) with molecular confirmation of LC-FAOD via genetic testing or enzyme activity. In Texas, you have strong appeal rights including expedited external review through Independent Review Organizations. First step today: Contact your board-certified medical geneticist

How to Get Exondys 51 (Eteplirsen) Covered by Cigna in Texas: Complete Prior Authorization Guide

Answer Box: Fastest Path to Exondys 51 Coverage To get Exondys 51 (eteplirsen) covered by Cigna in Texas: Submit prior authorization through CoverMyMeds or fax to (855) 840-1678 with genetic testing confirming exon 51-skipping DMD mutation, 6-minute walk test ≥180 meters, and prescription from a neuromuscular specialist. If denied, you

How to Get Tavalisse (fostamatinib) Covered by UnitedHealthcare in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tavalisse Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Tavalisse (fostamatinib) in adults with chronic ITP who had insufficient response to prior treatments like corticosteroids, immunoglobulins, or TPO receptor agonists. Your hematologist submits electronically via the UHC Provider Portal with diagnosis confirmation (ICD-10 D69.3)

Myths vs. Facts: Getting Signifor / Signifor LAR (pasireotide) Covered by Cigna in Texas

Answer Box: Getting Signifor / Signifor LAR (pasireotide) Covered by Cigna in Texas Cigna requires prior authorization for Signifor/Signifor LAR through Express Scripts/Accredo specialty pharmacy. For acromegaly, you must first try and fail octreotide LAR and lanreotide depot. For Cushing's disease, step therapy is less restrictive. Key

How to Get Orfadin (nitisinone) Covered by Humana in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Orfadin (nitisinone) Covered by Humana in Texas Orfadin (nitisinone) requires prior authorization from Humana and is typically non-formulary, requiring medical necessity documentation for hereditary tyrosinemia type 1 (HT-1). The fastest path to approval: 1) Verify your plan's formulary tier via Humana's drug list