Topic

Texas

A collection of 421 issues

Renewing Myozyme (Alglucosidase Alfa) Coverage with Aetna CVS Health in Texas: 2025 Requirements and Timeline

Quick Answer: Myozyme Renewal Requirements Aetna CVS Health requires annual prior authorization renewal for Myozyme (alglucosidase alfa) in Texas. Start your renewal 60-90 days before expiration. Submit updated diagnostic confirmation (GAA enzyme/genetic testing), specialist evaluation notes, treatment response documentation, and medical necessity letter. If denied, you have 180 days

Renewing Uplizna (Inebilizumab) Coverage with UnitedHealthcare in Texas: 2025 Timeline & Documentation Guide

Answer Box: Renewing Uplizna Coverage in Texas UnitedHealthcare requires annual renewal for Uplizna (inebilizumab) with clinical documentation of continued benefit. Start 60-90 days before your current authorization expires. Submit via the UnitedHealthcare Provider Portal with updated clinical notes, lab results, and specialist attestation. If denied, you have 180 days to

How to Get Retevmo (Selpercatinib) Covered by Cigna in Texas: Appeals, Copay Cards & Cost Solutions

Quick Answer: Getting Retevmo (Selpercatinib) Covered by Cigna in Texas Retevmo requires prior authorization from Cigna and is typically placed on a high specialty tier (4 or 5) with significant out-of-pocket costs. Your fastest path to approval: 1) Ensure you have genetic testing confirming RET fusion/mutation, 2) Have your

How to Get Rylaze (Asparaginase Erwinia) Covered by Blue Cross Blue Shield Texas: Prior Authorization, Appeals & Forms Guide

Quick Answer: Getting Rylaze Covered by BCBS Texas Rylaze (asparaginase erwinia chrysanthemi [recombinant]-rywn) is covered by Blue Cross Blue Shield of Texas but requires strict prior authorization. You'll need documented hypersensitivity to E. coli asparaginase, ALL/LBL diagnosis, and provider submission through BCBS specialty pharmacy network. First

Renewing Stelara (Ustekinumab) Approval with Blue Cross Blue Shield of Texas: 2025 Requirements & Timeline

Answer Box: Renewing Stelara with Blue Cross Blue Shield of Texas Blue Cross Blue Shield of Texas requires annual prior authorization renewal for Stelara (ustekinumab) 30-60 days before expiration. You'll need updated clinical documentation showing continued medical necessity and treatment response. Start early: BCBSTX makes decisions within 3

Complete Guide: Getting Lumizyme (Alglucosidase Alfa) Covered by UnitedHealthcare in Texas - ICD-10 Codes, HCPCS Billing, and Appeals Process

Quick Answer: Getting Lumizyme Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Lumizyme (alglucosidase alfa) in Texas. The fastest path to approval requires: (1) confirmed Pompe disease diagnosis with ICD-10 code E74.02, (2) genetic testing or enzyme assay documentation, and (3) medical necessity letter from a specialist.

Getting Elevidys Gene Therapy Covered by Aetna CVS Health in Texas: Complete Prior Authorization and Appeal Guide

Answer Box: Fast Track to Elevidys Coverage Elevidys requires prior authorization from Aetna CVS Health and must be administered at designated Gene Based, Cellular and Other Innovative Therapy (GCIT) Centers of Excellence in Texas. Start by confirming your child meets FDA criteria (age 4-5, ambulatory, confirmed DMD genetic mutation without

Cigna's Coverage Criteria for Vimizim (elosulfase alfa) in Texas: What Counts as "Medically Necessary"?

Answer Box: Getting Vimizim (elosulfase alfa) Covered by Cigna in Texas Cigna requires prior authorization for Vimizim (elosulfase alfa) with strict medical necessity criteria. You'll need confirmed MPS IVA diagnosis via enzyme testing, prescription from a geneticist or metabolic specialist, and documented baseline functional assessments. Fastest path: Have

How Long Does It Take to Get Venclexta (venetoclax) Approved by UnitedHealthcare in Texas? Timeline & Appeals Guide

Answer Box: Getting Venclexta Approved by UnitedHealthcare in Texas Timeline: UnitedHealthcare processes Venclexta (venetoclax) prior authorization in 24 hours for urgent requests and 72 hours for standard requests in Texas. OptumRx's automated system can approve in as little as 29 seconds if all criteria are met electronically. Fastest

How to Get Thiola / Thiola EC (tiopronin) Covered by UnitedHealthcare in Texas: Prior Authorization, Appeals, and Billing Guide

Quick Answer: UnitedHealthcare requires prior authorization for Thiola/Thiola EC (tiopronin) with step therapy requirements in Texas. Success requires documenting cystinuria diagnosis (ICD-10: E72.01), failed conservative therapy, and specialist evaluation. If denied, Texas law provides internal appeals (180 days) and binding external review through Independent Review Organizations (IROs). Start