Topic

Texas

A collection of 421 issues

Getting Xembify (Immune Globulin, SC) Covered by Cigna in Texas: Prior Authorization, Appeals, and Medical Necessity Guide

Answer Box: Quick Path to Xembify Coverage Getting Xembify approved by Cigna in Texas requires prior authorization through Express Scripts/Accredo. Your doctor must document primary immunodeficiency with IgG levels below normal ranges and recurrent infections. If denied, you have 180 days to appeal internally, followed by binding external review

How to Get Somatuline Depot (Lanreotide) Covered by Humana in Texas: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Somatuline Depot Covered by Humana in Texas Eligibility: Humana Medicare Advantage requires prior authorization for Somatuline Depot (lanreotide) for acromegaly, GEP-NETs, and carcinoid syndrome. Fastest path: Have your endocrinologist or oncologist submit PA with documented octreotide trial failure/intolerance, complete diagnostic workup (IGF-1, chromogranin A, or 5-HIAA)

How to Get Abecma (idecabtagene vicleucel) Covered by Humana in Texas: Appeals Guide with Templates

Answer Box: Getting Abecma Covered by Humana in Texas Abecma (idecabtagene vicleucel) requires prior authorization from Humana and must be administered at FACT-accredited centers. The fastest path to approval: 1. Verify eligibility: Relapsed/refractory multiple myeloma after ≥3 prior therapies (IMiD, proteasome inhibitor, anti-CD38) 2. Submit PA request: Through Humana&

Renewing Evkeeza (Evinacumab-dgnb) Approval with Blue Cross Blue Shield of Texas: Complete Timeline and Documentation Guide

Answer Box: Evkeeza Renewal Essentials for BCBS Texas Blue Cross Blue Shield of Texas requires renewal authorization for Evkeeza (evinacumab-dgnb) every 6-12 months. Start your renewal process 30 days before expiration to avoid treatment gaps. You'll need updated labs showing continued elevated LDL-C levels, proof of adherence to

How to Get Elelyso (taliglucerase alfa) Covered by Cigna in Texas: Formulary Alternatives & Exception Paths

Quick Answer: Elelyso (taliglucerase alfa) often requires prior authorization and may be non-formulary with Cigna. In Texas, you have 180 days to appeal denials through internal review, then external review via an Independent Review Organization. First step: Check if Cigna prefers Cerezyme or VPRIV, then gather medical necessity documentation from

How to Get Myalept (Metreleptin) Covered by Blue Cross Blue Shield of Texas: Forms, Appeals & Support

Answer Box: Getting Myalept Covered by BCBS Texas Myalept (metreleptin) requires prior authorization from Blue Cross Blue Shield of Texas for patients with confirmed generalized lipodystrophy. The fastest path: 1) Have your endocrinologist complete the BCBS Texas PA form with documented metabolic complications and failed conventional therapy, 2) Submit through

If Xenpozyme (Olipudase Alfa-rpcp) Isn't Approved by Aetna (CVS Health) in Texas: Formulary Alternatives & Exception Paths

Quick Answer: Currently, there are no FDA-approved alternatives to Xenpozyme (olipudase alfa-rpcp) for acid sphingomyelinase deficiency (ASMD). If Aetna (CVS Health) denies coverage in Texas, your best path is requesting a formulary exception with comprehensive medical documentation, followed by internal appeals and external review through Texas Department of Insurance if

Humana's Coverage Criteria for Translarna (Ataluren) in Texas: Complete Guide to Medical Necessity and Appeals

Answer Box: Getting Translarna (Ataluren) Covered by Humana in Texas Current Status: Translarna is not yet FDA-approved in the US (pending 2024 NDA review). For Texas residents with Humana coverage: 1. Monitor FDA approval status - PTC Therapeutics resubmitted their application in late 2024 2. Prepare documentation now - genetic

Getting Voydeya (Danicopan) Covered by Humana in Texas: Formulary Alternatives & Appeals Guide

Answer Box: Getting Voydeya (Danicopan) Covered by Humana in Texas Voydeya (danicopan) is not specifically listed on Humana Medicare Advantage formularies for 2025, but coverage may be available through a formulary exception request. As an add-on therapy for PNH patients already on C5 inhibitors, your fastest path to approval involves:

Myths vs. Facts: Getting Luxturna (voretigene neparvovec-rzyl) Covered by Aetna (CVS Health) in Texas

Answer Box: Getting Luxturna Covered by Aetna in Texas Luxturna (voretigene neparvovec-rzyl) requires prior authorization from Aetna CVS Health and must be administered at an Aetna Institutes® GCIT Network facility. Coverage requires confirmed biallelic RPE65 genetic testing, viable retinal cells (≥100 μm on OCT), and prescription by an ophthalmologist. If