Topic

Texas

A collection of 49 issues

How to Get Vitrakvi (Larotrectinib) Covered by Aetna CVS Health in Texas: Complete Coverage and Appeal Guide

Answer Box: Getting Vitrakvi Covered by Aetna CVS Health in Texas Vitrakvi (larotrectinib) requires prior authorization with Aetna CVS Health in Texas and documentation of a positive NTRK gene fusion test. The fastest path to approval: (1) Ensure your oncologist has your NTRK fusion test results ready, (2) Submit the

Myths vs. Facts: Getting Epidiolex (Cannabidiol) Covered by Humana in Texas

Answer Box: Getting Epidiolex Covered by Humana in Texas Myth: "If denied, you can't get Epidiolex." Fact: Humana requires prior authorization for Epidiolex in Texas, but denials are often overturned with proper documentation. Success requires: (1) confirmed diagnosis of LGS, Dravet syndrome, or TSC, (2) documented

How to Get Prolastin-C Covered by Humana in Texas: Complete Requirements Checklist and Appeals Guide

Quick Answer: Getting Prolastin-C Covered by Humana in Texas Prolastin-C requires prior authorization from Humana with strict clinical documentation. You'll need confirmed Pi*ZZ genotype, AAT levels below 11 µM, FEV₁ between 30-65% predicted, and emphysema documentation. First step today: Have your doctor submit a prior authorization request

How to Get Amondys 45 (Casimersen) Covered by Aetna CVS Health in Texas: Complete Appeal Guide with Templates

Answer Box: Getting Amondys 45 Covered by Aetna CVS Health in Texas Aetna CVS Health requires prior authorization for Amondys 45 (casimersen) with strict genetic and clinical documentation. The fastest path to approval: 1. Gather genetic testing confirming DMD with exon 45 amenable mutation 2. Submit Aetna's precertification

Renewing Ultomiris (Ravulizumab) Coverage with UnitedHealthcare in Texas: Annual Reapproval Guide and Timeline

Answer Box: Renewing Ultomiris Coverage with UnitedHealthcare in Texas UnitedHealthcare requires annual prior authorization renewal for Ultomiris (ravulizumab) with updated clinical documentation proving continued medical necessity. Start the renewal process 60-90 days before your current approval expires. Submit through the UnitedHealthcare Provider Portal with current lab results, treatment response data,

How to Get Adynovate Approved by Humana in Texas: Complete Prior Authorization Guide

Answer Box: Adynovate (bdanocog alfa pegol) requires prior authorization from Humana Medicare plans in Texas. The fastest path: (1) Have your hematologist submit the "Request for Medicare Prescription Drug Coverage Determination" form via fax to 877-486-2621 with hemophilia A diagnosis, factor VIII level <1-5%, and bleeding history

Myths vs. Facts: Getting Vimizim (Elosulfase Alfa) Covered by UnitedHealthcare in Texas

Answer Box: Getting Vimizim Covered by UnitedHealthcare in Texas Vimizim (elosulfase alfa) requires prior authorization from UnitedHealthcare OptumRx for all Texas residents. The fastest path to approval involves three steps: 1) Ensure your prescriber is a metabolic specialist or geneticist, 2) Submit complete diagnostic documentation (GALNS enzyme activity test and

How to Get Eylea and Lucentis Covered by Blue Cross Blue Shield of Texas: Complete Prior Authorization Guide

Quick Answer: Getting Eylea/Lucentis Approved by BCBS Texas Blue Cross Blue Shield of Texas requires prior authorization for Eylea (aflibercept) and Lucentis (ranibizumab). Most plans require step therapy with bevacizumab (Avastin) first, unless contraindicated. Submit requests through Availity Essentials with OCT imaging, visual acuity records, and diagnosis documentation. Standard

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

Answer Box: Getting Ilaris (Canakinumab) Covered by Aetna CVS Health in Texas Standard approval timeline: 30-45 days for prior authorization, with over 95% of eligible requests processed within 24 hours. Expedited reviews for urgent cases must be completed within 72 hours under Texas law. Fastest path to approval: 1. Prescriber

Do You Qualify for Cystadane Coverage by Humana in Texas? Decision Tree & Next Steps

Answer Box: If you have confirmed homocystinuria with elevated homocysteine (>50 µmol/L) and documented CBS, MTHFR, or cobalamin deficiency, you likely qualify for Cystadane coverage through Humana in Texas. The fastest path: have your doctor submit prior authorization with genetic testing results, plasma homocysteine levels, and vitamin B6/