Topic

Texas

A collection of 418 issues

How to Get Uptravi (Selexipag) Covered by Aetna CVS Health in Texas: Complete PA Guide and Appeals Process

Answer Box: Getting Uptravi (Selexipag) Covered by Aetna CVS Health in Texas Eligibility: Aetna CVS Health requires prior authorization for Uptravi (selexipag) with strict documentation: WHO Group I PAH diagnosis, right heart catheterization results, functional class II-IV status, and failure of 2+ oral PAH therapies (60 days each). Fastest path:

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

Answer Box: Getting Vanflyta (Quizartinib) Covered by Cigna in Texas Vanflyta (quizartinib) requires prior authorization from Cigna and typically involves step therapy requirements. Most approvals take 7-14 days with complete documentation. Fastest path: 1) Confirm FLT3-ITD positive AML diagnosis with genetic testing results, 2) Document failure/intolerance of preferred FLT3

Coding That Helps Get Vimizim (Elosulfase Alfa) Approved by Humana in Texas: ICD-10, HCPCS, and Billing Guide

Answer Box: Getting Vimizim Covered by Humana in Texas Primary requirement: Confirmed MPS IVA diagnosis with reduced GALNS enzyme activity or genetic testing. Fastest path: Use ICD-10 code E76.210, HCPCS J1322 for medical benefit billing, and submit comprehensive diagnostic documentation through Humana's provider portal. First step today:

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

Answer Box: When Lutathera Isn't Covered If Blue Cross Blue Shield of Texas denies Lutathera (lutetium Lu-177 dotatate) for your neuroendocrine tumor, you have three main paths: 1) Try required formulary alternatives like octreotide or lanreotide first (step therapy), 2) Request a formulary exception with medical necessity documentation,

How to Get Procysbi (Cysteamine Bitartrate DR) Covered by Blue Cross Blue Shield of Texas: Timeline, Appeals, and PA Requirements

Quick Answer: Getting Procysbi Covered by BCBS Texas Procysbi requires prior authorization from Blue Cross Blue Shield of Texas for all commercial plans as of July 2024. The fastest path to approval: (1) Confirm nephropathic cystinosis diagnosis with WBC cystine levels, (2) Submit PA through the BCBS Texas provider portal

How to Get Defitelio (defibrotide) Covered by UnitedHealthcare in Texas: PA Requirements, Appeals, and Cost Assistance

Answer Box: Getting Defitelio Covered by UnitedHealthcare in Texas Defitelio (defibrotide) is covered by UnitedHealthcare with prior authorization required. For hepatic VOD/SOS post-HSCT, no step therapy applies. Your fastest path: 1) Have your transplant team submit PA through Optum Specialty Pharmacy with complete HSCT documentation, 2) If denied, file

Renewing Poteligeo (Mogamulizumab-kpkc) Approval with Cigna in Texas: 2025 Requirements, Timeline, and Appeal Options

Quick Answer: Renewing Your Poteligeo Coverage with Cigna in Texas Poteligeo (mogamulizumab-kpkc) requires annual renewal with Cigna, typically 30-60 days before your current authorization expires. Submit updated TNMB staging, pathology reports, flow cytometry results (for Sézary syndrome), proof of clinical benefit, and specialist consultation notes. Cigna reviews within 72 hours

Resources to Get Amvuttra (vutrisiran) Approved with Humana in Texas: Complete Forms, Portals & Appeal Guide

Answer Box: Getting Amvuttra (vutrisiran) Covered by Humana in Texas Fastest path to approval: Submit the current Humana Medicare Prior Authorization Form for Amvuttra via Availity Essentials portal or fax to 1-888-447-3430, including genetic confirmation for hATTR-PN or cardiomyopathy documentation for ATTR-CM. If denied, you have 65 days to appeal

Renewing Exondys 51 (Eteplirsen) Approval with Aetna CVS Health in Texas: 2025 Requirements and Timeline

Answer Box: Quick Renewal Guide Exondys 51 renewal with Aetna CVS Health requires 6-month prior authorization cycles with specific documentation. Start 60 days before expiration. Three key steps: (1) Schedule neurologist visit within 6 months, (2) Complete cardiac echo and renal labs within 12 months, (3) Document functional stability using

UnitedHealthcare's Coverage Criteria for Hetlioz (Tasimelteon) in Texas: What Counts as "Medically Necessary"?

Answer Box: Getting Hetlioz Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Hetlioz (tasimelteon) with strict medical necessity criteria. Coverage is limited to totally blind adults with Non-24-Hour Sleep-Wake Disorder or confirmed Smith-Magenis Syndrome patients (ages 3-15 for oral suspension, 16+ for capsules). Step therapy with melatonin is