Topic

Texas

A collection of 404 issues

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,

Get Tegsedi (Inotersen) Covered by Aetna CVS Health in Texas: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Tegsedi (inotersen) covered by Aetna CVS Health in Texas requires prior authorization with documented hATTR polyneuropathy diagnosis, genetic testing confirming TTR mutation, REMS program enrollment, and specialist prescription. Start by having your neurologist submit the PA request through Aetna's provider portal with complete clinical documentation.

Getting Acthar Gel Approved by Blue Cross Blue Shield of Texas: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Acthar Gel Covered by BCBS Texas Acthar Gel requires prior authorization from Blue Cross Blue Shield of Texas, with approval based on FDA-approved indications and documented failure of corticosteroids. Your fastest path to approval: (1) Have your prescriber submit a detailed PA request through the BCBS provider

How Long Does It Take to Get Oxlumo (Lumasiran) Approved by Aetna CVS Health in Texas? Complete Timeline Guide

Answer Box: Oxlumo Approval Timeline with Aetna CVS Health in Texas Standard approval: 14-45 days for complete submissions; expedited/urgent: within 72 hours. Aetna processes 95% of eligible specialty drug requests within 24 hours when all documentation is complete. Key requirements: Confirmed PH1 diagnosis via AGXT genetic testing, specialist prescriber,

How to Get Arikayce Covered by Blue Cross Blue Shield in Texas: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Arikayce Covered in Texas Arikayce (amikacin liposome inhalation) requires prior authorization from Blue Cross Blue Shield of Texas and typically costs over $100,000 annually. To get coverage: 1. Submit PA request with documentation of 6+ months failed MAC combination therapy 2. Use specialty pharmacy (mail order

Work With Your Doctor to Get Helixate (rFVIII) Covered by Aetna CVS Health in Texas: Provider Partnership Guide

Answer Box: Getting Helixate (rFVIII) Covered by Aetna CVS Health in Texas Note: Helixate and Kogenate FS have been discontinued in the US. Your doctor will need to transition you to an available alternative like Kovaltry, Advate, or Jivi. To get coverage approved: (1) Schedule a visit with your hematologist

Coding That Helps Get Haegarda Covered by UnitedHealthcare in Texas: ICD-10, J-Code, and NDC Requirements

Answer Box: Getting Haegarda Covered by UnitedHealthcare in Texas Fastest Path: Submit prior authorization with ICD-10 code D84.1 (hereditary angioedema), specialist documentation, and lab evidence of C1-INH deficiency. Use J-code J0599 for billing (10 units per code). UnitedHealthcare requires specialist prescriber and confirmed HAE diagnosis—no absolute step therapy

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

Answer Box: Getting Krystexxa Approved by BCBS Texas Blue Cross Blue Shield of Texas requires prior authorization for Krystexxa (pegloticase) with specific clinical criteria: documented refractory gout, failed trials of allopurinol and febuxostat, persistent serum uric acid ≥6 mg/dL, and normal G6PD testing. Submit through the Availity Authorization portal

Getting Pombiliti Covered by Blue Cross Blue Shield of Texas: Prior Authorization, Appeals & Financial Assistance Guide

Answer Box: How to Get Pombiliti Covered by Blue Cross Blue Shield of Texas Pombiliti (cipaglucosidase alfa-atga) is not on the 2024 BCBS Texas formulary, requiring a prior authorization or formulary exception. Your fastest path to coverage: (1) Have your specialist submit a detailed prior authorization request with documented Pompe