Topic

Texas

A collection of 402 issues

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

How to Get Humate-P Covered by Humana in Texas: Prior Authorization, Appeals, and Financial Assistance

Answer Box: Getting Humate-P Covered by Humana in Texas Humana requires prior authorization for Humate-P (antihemophilic factor/vWF complex), typically with step therapy requiring trials of preferred alternatives first. In Texas, patients have 180 days to file internal appeals and can request independent external review through the Texas Department of

How to Get Krystexxa (Pegloticase) Covered by UnitedHealthcare in Texas: Complete Timeline and Appeals Guide

Answer Box: Getting Krystexxa Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Krystexxa (pegloticase) with strict step therapy and documentation requirements. The standard approval timeline is 15 days for complete submissions, with expedited reviews decided within 24 hours for urgent cases. To start: gather evidence of failed allopurinol

Getting Pomalyst (Pomalidomide) Covered by Cigna in Texas: Prior Authorization, Appeals, and State Protection Guide

Answer Box: Your Fastest Path to Coverage Getting Pomalyst (pomalidomide) covered by Cigna in Texas requires prior authorization with proof of multiple myeloma diagnosis, failure of lenalidomide and a proteasome inhibitor, and REMS enrollment. If denied, you have 180 days to appeal internally, then can request Texas Independent Review Organization

How to Get HyperHEP Covered by Blue Cross Blue Shield of Texas: Forms, Appeals & Contact Guide 2025

Answer Box: Getting HyperHEP Covered by BCBS Texas Quick Path to Coverage: Most Blue Cross Blue Shield of Texas (BCBSTX) plans cover HyperHEP (hepatitis B immune globulin) for post-exposure prophylaxis when administered within 24 hours of exposure. HealthSelect members need no prior authorization as of September 2024, but require a

Getting Zanzalintinib (XL092) Covered by Cigna in Texas: Complete Coding, Appeals, and Prior Authorization Guide

Answer Box: Getting Zanzalintinib (XL092) Covered by Cigna in Texas Zanzalintinib (XL092) is investigational and typically denied by Cigna, but coverage is possible through prior authorization and appeals. Start with your oncologist submitting a detailed PA request using ICD-10 codes specific to your cancer type and HCPCS code J3490. If

How to Get iLink® Corneal Cross-Linking Covered by Cigna in Texas: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting iLink® Covered by Cigna in Texas Cigna covers iLink® corneal cross-linking for progressive keratoconus when you meet specific criteria: age 14-65, documented disease progression, and use of the FDA-approved epithelium-off protocol only. Your fastest path: Have your ophthalmologist submit prior authorization with serial topography showing progression (≥1

Getting Zanzalintinib (XL092) Covered by Humana in Texas: Appeals Process and State Protections

Quick Answer: Getting Zanzalintinib (XL092) Covered by Humana in Texas Zanzalintinib (XL092) is an investigational drug typically denied by Humana outside clinical trials. However, Texas law provides strong appeal rights for investigational treatments. Your fastest path: Request a formulary exception with clinical documentation, then if denied, file for Texas Independent

How to Get Cabometyx (cabozantinib) Covered by Blue Cross Blue Shield of Texas: Forms, Appeals, and Specialty Pharmacy Guide

Answer Box: Getting Cabometyx Covered by BCBS Texas Cabometyx (cabozantinib) requires prior authorization from Blue Cross Blue Shield of Texas for all 2024 commercial plans. Submit your request through CoverMyMeds or the BCBS Texas provider portal with complete clinical documentation including diagnosis, prior treatments, and medical necessity justification. If denied,