Topic

Texas

A collection of 49 issues

How to Get Eylea and Lucentis Covered by UnitedHealthcare in Texas: Prior Authorization Forms, Appeals, and Step Therapy Guide

Answer Box: Getting Started in Texas UnitedHealthcare requires prior authorization for both Eylea (aflibercept) and Lucentis (ranibizumab) in Texas, with step therapy typically requiring bevacizumab first unless contraindicated. Both drugs are placed in Tier 4 (Specialty) with higher copays or coinsurance. Fastest approval path: (1) Have your retina specialist submit

How to Get Eloctate Covered by Humana in Texas: Complete Prior Authorization Guide with Forms and Appeals

Answer Box: Getting Eloctate Covered by Humana in Texas Eloctate (efmoroctocog alfa) requires prior authorization from Humana in Texas for all plan types. The fastest path: Have your hematologist submit a PA request with complete clinical documentation via Humana's provider portal or fax to 877-486-2621. Include diagnosis, factor

If Keytruda Isn't Approved by Blue Cross Blue Shield in Texas: Formulary Alternatives & Exception Paths

Quick Answer: If Blue Cross Blue Shield of Texas denies Keytruda (pembrolizumab), formulary alternatives include Opdivo (nivolumab), Tecentriq (atezolizumab), Imfinzi (durvalumab), and Libtayo (cemiplimab). Submit a Prescription Drug Coverage Exception form with detailed medical documentation showing why preferred drugs failed or are contraindicated. Internal appeals have 72-hour decisions, with external

How to Get Cystadane (Betaine Anhydrous) Covered by Cigna in Texas: Complete Guide to Prior Authorization, Appeals, and Approval

Answer Box: Getting Cystadane Covered by Cigna in Texas Eligibility: Cigna covers Cystadane (betaine anhydrous) for homocystinuria due to CBS, MTHFR, or cobalamin metabolism defects with prior authorization. Fastest approval path: Submit complete documentation including genetic/enzyme testing, vitamin therapy trial records, and specialist oversight from a metabolic/genetic disease

How to Get Natpara Covered by UnitedHealthcare in Texas: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Natpara Covered by UnitedHealthcare in Texas Important Update: Natpara (parathyroid hormone) was discontinued by Takeda at the end of 2024, with no new commercial supply available. For patients currently on Natpara, work with your endocrinologist to transition to conventional therapy (calcium and vitamin D analogs) before existing

Renewing Vimizim (Elosulfase Alfa) Approval with Blue Cross Blue Shield of Texas: 2025 Requirements & Timeline

Answer Box: Vimizim Renewal with Blue Cross Blue Shield of Texas Good news for HealthSelect members: As of September 2024, Blue Cross Blue Shield of Texas HealthSelect plans no longer require prior authorization for Vimizim (elosulfase alfa) renewals. However, you still need an in-network PCP referral on file. For other

Get Xospata (Gilteritinib) Covered by Cigna in Texas: Complete Guide to Prior Authorization and Appeals

Answer Box: Your Path to Xospata Coverage Cigna requires prior authorization for Xospata (gilteritinib) in Texas. To get approved: (1) Ensure you have relapsed/refractory AML with documented FLT3 mutation via FDA-approved test, (2) Have your hematologist/oncologist submit prior authorization with complete treatment history, and (3) If denied, file

Getting Ozempic and Mounjaro Covered by Aetna CVS Health in Texas: Complete Prior Authorization Guide

Answer Box: How to Get Ozempic or Mounjaro Covered by Aetna CVS Health in Texas Both Ozempic (semaglutide) and Mounjaro (tirzepatide) require prior authorization from Aetna CVS Health in Texas. The fastest path to approval: 1) Have your doctor submit a prior authorization request with documented metformin failure and proper

Work With Your Doctor to Get Revlimid (Lenalidomide) Approved by Humana in Texas: Complete Provider Collaboration Guide

Answer Box: Getting Revlimid Approved by Humana in Texas Fast Track to Approval: Humana requires prior authorization for Revlimid (lenalidomide) with strict REMS compliance and comprehensive clinical documentation. Success depends on your doctor submitting complete treatment history, diagnosis confirmation, and REMS certification. First step today: Schedule an appointment with your

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

Answer Box: Getting Dojolvi Covered by Aetna CVS Health in Texas Dojolvi (triheptanoin) requires prior authorization from Aetna CVS Health and is not on the 2024 formulary, requiring a formulary exception. Essential requirements include genetic/biochemical LC-FAOD confirmation, specialist documentation, and proof that dietary management alone is inadequate. First step