Topic

Texas

A collection of 421 issues

How to Get Onpattro (Patisiran) Covered by UnitedHealthcare in Texas: Complete Coding and Appeals Guide

Answer Box: Getting Onpattro Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Onpattro (patisiran) with strict medical necessity criteria including genetic confirmation of hATTR-PN, neurologist evaluation, and specific disease staging. Use ICD-10 code E85.1, HCPCS J0222, and ensure complete documentation before submission. If denied, Texas law guarantees

The Requirements Checklist to Get Orladeyo (berotralstat) Covered by UnitedHealthcare in Texas: Forms, Appeals, and Timeline

Answer Box: Getting Orladeyo Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Orladeyo (berotralstat) in Texas. The fastest path: (1) Confirm HAE diagnosis with C1-INH lab results, (2) Submit OptumRx PA form with complete clinical documentation, (3) Use electronic submission for 24-72 hour decisions. New users may face

How to Get Myozyme (Alglucosidase Alfa) Covered by Humana in Texas: Complete Guide to Forms, Appeals & Approval

Answer Box: Getting Myozyme Covered by Humana in Texas Fastest path to approval: Humana requires prior authorization for Myozyme (alglucosidase alfa) using HCPCS code J0221. Your doctor submits the request via Humana's provider portal, by fax to 877-486-2621, or by calling 800-555-CLIN (2546). Include confirmed Pompe disease diagnosis,

If Brensocatib (BRINSUPRI) Isn't Approved by Blue Cross Blue Shield in Texas: Formulary Alternatives & Exception Paths

Quick Answer: If Blue Cross Blue Shield Texas denies Brensocatib (BRINSUPRI), you have formulary alternatives like azithromycin and airway clearance therapy. File a formulary exception request with 72-hour decision timeline, or appeal denials through Texas's independent review process. Start by checking your specific plan's drug list

How to Get Cimzia (Certolizumab Pegol) Covered by Humana in Texas: Prior Authorization, Step Therapy & Appeals Guide

Quick Answer: Getting Cimzia Covered by Humana in Texas Cimzia (certolizumab pegol) requires prior authorization from Humana and is subject to step therapy requirements. Your fastest path to approval: 1) Have your doctor document failed trials of preferred anti-TNF biosimilars, 2) Submit a medical necessity letter with your PA request

Lowering Out-of-Pocket Costs for Bylvay (odevixibat) with UnitedHealthcare in Texas: Copay Assistance, Tiering Exceptions & Financial Aid

Quick Answer: Reducing Your Bylvay Costs in Texas Bylvay (odevixibat) costs $14,152-$44,562 monthly with UnitedHealthcare, but multiple cost-reduction strategies exist. Commercially insured patients can access IPSEN CARES copay assistance (potentially $0 copay), while Medicare/Medicaid patients need foundation grants. Key steps: 1) Apply for IPSEN CARES immediately,

Getting Somatuline Depot (Lanreotide) Covered by Cigna in Texas: Prior Authorization, Appeals, and Cost-Saving Strategies

Quick Answer: Cigna requires prior authorization for Somatuline Depot (lanreotide) with documentation of octreotide trial unless contraindicated. Your endocrinologist/oncologist must submit medical necessity forms within 72 hours for standard review. If denied, file internal appeal within 180 days, then external review through Texas IRO within 4 months. Commercial patients

How to Get Ruconest (C1 Esterase Inhibitor) Covered by Blue Cross Blue Shield in Texas: Complete 2024 Guide with Forms and Appeal Process

Quick Answer: Getting Ruconest Covered by BCBS Texas Yes, Blue Cross Blue Shield of Texas covers Ruconest for hereditary angioedema (HAE), but requires prior authorization. Your fastest path: 1) Gather HAE diagnosis confirmation (C1-INH lab results), 2) Document attack history with your specialist, and 3) Submit prior authorization through the

If Soliris (Eculizumab) Isn't Approved by UnitedHealthcare in Texas: Formulary Alternatives & Exception Strategies

Answer Box: If Soliris Is Denied by UnitedHealthcare in Texas If UnitedHealthcare denies Soliris (eculizumab) in Texas, you have three main paths: try biosimilar alternatives (Bkemv, Epysqli) that are often preferred on formulary, request a medical exception with clinical documentation showing alternatives aren't suitable, or pursue the appeals

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

Answer Box: Getting Gilenya Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Gilenya (fingolimod) in Texas. Submit through the UnitedHealthcare Provider Portal with complete documentation: baseline EKG, ophthalmology exam, vaccination records, and step therapy documentation. If denied, you have 60 days for internal appeal, then 4 months for