Topic

Texas

A collection of 422 issues

How to Get Mycapssa (Octreotide Oral) Covered by Cigna in Texas: PA Forms, Appeals & Success Tips

Answer Box: Getting Mycapssa Covered by Cigna in Texas Mycapssa (oral octreotide) requires prior authorization from Cigna with specific documentation: acromegaly diagnosis, prior response to injectable octreotide/lanreotide for 3+ months, and endocrinologist prescription. Fastest path: Have your endocrinologist submit PA with baseline IGF-1 labs, treatment history, and medical necessity

How to Get Spinraza (nusinersen) Covered by Blue Cross Blue Shield of Texas: Prior Authorization, Appeals & Success Strategies

Answer Box: Getting Spinraza Covered by BCBS Texas Spinraza (nusinersen) requires prior authorization from Blue Cross Blue Shield of Texas before coverage begins. The fastest path to approval involves three key steps: 1) Have your neurologist submit comprehensive medical documentation through the Availity Portal, including genetic SMA confirmation and baseline

How to Get Stelara (Ustekinumab) Covered by Cigna in Texas: Appeals Guide with Forms and Timelines

Quick Answer: Getting Stelara Covered by Cigna in Texas Step 1: Your doctor submits prior authorization to Cigna (required for all Stelara prescriptions). Step 2: If denied, request a peer-to-peer review within 180 days. Step 3: File internal appeal with medical necessity letter and supporting documents. Step 4: If still

How to Get Eylea and Lucentis Covered by UnitedHealthcare in Texas: Prior Authorization Forms, Appeals, and Step Therapy Guide

Answer Box: Getting Started in Texas UnitedHealthcare requires prior authorization for both Eylea (aflibercept) and Lucentis (ranibizumab) in Texas, with step therapy typically requiring bevacizumab first unless contraindicated. Both drugs are placed in Tier 4 (Specialty) with higher copays or coinsurance. Fastest approval path: (1) Have your retina specialist submit

How to Get Eloctate Covered by Humana in Texas: Complete Prior Authorization Guide with Forms and Appeals

Answer Box: Getting Eloctate Covered by Humana in Texas Eloctate (efmoroctocog alfa) requires prior authorization from Humana in Texas for all plan types. The fastest path: Have your hematologist submit a PA request with complete clinical documentation via Humana's provider portal or fax to 877-486-2621. Include diagnosis, factor

If Keytruda Isn't Approved by Blue Cross Blue Shield in Texas: Formulary Alternatives & Exception Paths

Quick Answer: If Blue Cross Blue Shield of Texas denies Keytruda (pembrolizumab), formulary alternatives include Opdivo (nivolumab), Tecentriq (atezolizumab), Imfinzi (durvalumab), and Libtayo (cemiplimab). Submit a Prescription Drug Coverage Exception form with detailed medical documentation showing why preferred drugs failed or are contraindicated. Internal appeals have 72-hour decisions, with external

How to Get Cystadane (Betaine Anhydrous) Covered by Cigna in Texas: Complete Guide to Prior Authorization, Appeals, and Approval

Answer Box: Getting Cystadane Covered by Cigna in Texas Eligibility: Cigna covers Cystadane (betaine anhydrous) for homocystinuria due to CBS, MTHFR, or cobalamin metabolism defects with prior authorization. Fastest approval path: Submit complete documentation including genetic/enzyme testing, vitamin therapy trial records, and specialist oversight from a metabolic/genetic disease

How to Get Natpara Covered by UnitedHealthcare in Texas: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Natpara Covered by UnitedHealthcare in Texas Important Update: Natpara (parathyroid hormone) was discontinued by Takeda at the end of 2024, with no new commercial supply available. For patients currently on Natpara, work with your endocrinologist to transition to conventional therapy (calcium and vitamin D analogs) before existing

Renewing Vimizim (Elosulfase Alfa) Approval with Blue Cross Blue Shield of Texas: 2025 Requirements & Timeline

Answer Box: Vimizim Renewal with Blue Cross Blue Shield of Texas Good news for HealthSelect members: As of September 2024, Blue Cross Blue Shield of Texas HealthSelect plans no longer require prior authorization for Vimizim (elosulfase alfa) renewals. However, you still need an in-network PCP referral on file. For other

Get Xospata (Gilteritinib) Covered by Cigna in Texas: Complete Guide to Prior Authorization and Appeals

Answer Box: Your Path to Xospata Coverage Cigna requires prior authorization for Xospata (gilteritinib) in Texas. To get approved: (1) Ensure you have relapsed/refractory AML with documented FLT3 mutation via FDA-approved test, (2) Have your hematologist/oncologist submit prior authorization with complete treatment history, and (3) If denied, file