Topic

Texas

A collection of 384 issues

Myths vs. Facts: Getting Jynarque (tolvaptan) Covered by Aetna (CVS Health) in Texas

Answer Box: Get Jynarque Covered by Aetna in Texas Fast track to approval: Aetna (CVS Health) covers Jynarque for ADPKD with prior authorization requiring documented rapid progression (Mayo Class 1C-1E or eGFR decline ≥3.0 mL/min/1.73m²/year), nephrologist prescription, and REMS enrollment. Submit via CVS Caremark provider

Myths vs. Facts: Getting Zolgensma Covered by Blue Cross Blue Shield of Texas (2025 Guide)

Answer Box: The Truth About Zolgensma Coverage in Texas Fact: Blue Cross Blue Shield of Texas (BCBSTX) covers Zolgensma for eligible SMA patients when strict medical criteria are met. Your fastest path: Have your pediatric neurologist submit prior authorization with complete genetic testing (bi-allelic SMN1 mutation), anti-AAV9 antibody titer ≤1:

Do You Qualify for Raxone (idebenone) Coverage by UnitedHealthcare in Texas? Decision Tree & Next Steps

Answer Box: Getting Raxone (idebenone) Covered by UnitedHealthcare in Texas Raxone (idebenone) requires prior authorization through UnitedHealthcare's OptumRx specialty pharmacy division and faces coverage challenges due to its non-FDA-approved status in the US. The fastest path to approval involves: 1) Gathering confirmed LHON diagnosis with genetic testing results,

How to Get Hemlibra (emicizumab-kxwh) Covered by UnitedHealthcare in Texas: Complete PA Guide with Appeals Timeline

Quick Answer: Getting Hemlibra Approved by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Hemlibra (emicizumab-kxwh) in Texas, with approval based on hemophilia A diagnosis and factor VIII inhibitor status (≥5 Bethesda units for inhibitor-positive patients). Your hematologist must submit documentation through the UnitedHealthcare Provider Portal within 14 days for

How to Get Alecensa (alectinib) Covered by Cigna in Texas: Appeals Process, State Laws, and Approval Strategies

Answer Box: Getting Alecensa (alectinib) Covered by Cigna in Texas To get Alecensa (alectinib) approved by Cigna in Texas: Your oncologist must submit a prior authorization request through Express Scripts/Accredo with ALK-positive test results, prior therapy documentation, and medical necessity justification. If denied, you have 180 days to appeal

How to Get HyperHEP (Hepatitis B Immune Globulin) Covered by Cigna in Texas: Appeals Guide and Medical Necessity Templates

Answer Box: Getting HyperHEP Covered by Cigna in Texas Cigna requires prior authorization for HyperHEP (hepatitis B immune globulin) based on CDC post-exposure prophylaxis guidelines. Submit PA within 24-48 hours of exposure with documentation including incident report, source HBsAg status, and vaccination history. If denied, file Level 1 appeal within

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

Answer Box: Fast Track to Filspari Coverage in Texas To get Filspari (sparsentan) covered by Aetna CVS Health in Texas: Your nephrologist must submit a prior authorization showing biopsy-confirmed primary IgA nephropathy, UPCR ≥0.8 g/g, and 3+ months of failed ACE/ARB therapy. Complete REMS enrollment at filsparirems.

Work With Your Doctor to Get Kymriah (tisagenlecleucel) Approved by UnitedHealthcare in Texas: Complete Guide

Answer Box: Getting Kymriah Approved by UnitedHealthcare in Texas Kymriah (tisagenlecleucel) requires prior authorization from UnitedHealthcare OptumRx across all plans. The fastest path: work with your oncologist to submit a comprehensive prior authorization request including CD19-positive diagnosis, certified treatment center selection, and conditioning regimen plan. First step today: Contact your

How to Get iLink® Corneal Cross-Linking Covered by Blue Cross Blue Shield in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting iLink® Covered by BCBS Texas Blue Cross Blue Shield of Texas (BCBSTX) covers iLink® corneal cross-linking for progressive keratoconus when medically necessary per their 2024 policy. Success requires: (1) documented corneal progression (≥1 diopter change over 12 months via topography), (2) prior authorization through your ophthalmologist, and

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

Quick Answer: Getting Jynarque Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Jynarque (tolvaptan) with no step therapy, but coverage criteria are strict. You'll need ADPKD diagnosis documentation, rapid progression evidence (≥2.5 mL/min/1.73m²/year eGFR decline), and REMS enrollment. The fastest path: