Topic

Texas

A collection of 236 issues

How to Get Kalydeco (ivacaftor) Covered by Blue Cross Blue Shield of Texas: Prior Authorization Guide & Appeal Scripts

Answer Box: Getting Kalydeco Covered by Blue Cross Blue Shield of Texas Kalydeco (ivacaftor) is covered by Blue Cross Blue Shield of Texas with prior authorization, quantity limits (60 tablets per 30 days), and specialty pharmacy requirements. To get approval: (1) Confirm your CFTR mutation is FDA-approved for ivacaftor, (2)

How to Get Rylaze Covered by Aetna CVS Health in Texas: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Rylaze Covered by Aetna CVS Health in Texas Rylaze requires prior authorization from Aetna CVS Health in Texas. You need documented hypersensitivity to E. coli asparaginase, confirmed ALL/LBL diagnosis, and use in multi-agent chemotherapy. Start today: Have your oncologist submit PA with detailed hypersensitivity documentation via

How Long Does It Take to Get Elevidys Approved by Cigna in Texas? Complete Timeline & Requirements

Answer Box: Getting Elevidys Approved by Cigna in Texas Timeline: 5-15 business days for standard prior authorization once complete documentation is submitted. Expedited reviews take 72 hours for urgent cases. Fastest path to approval: 1. Confirm genetic DMD diagnosis and anti-AAVrh74 antibody titer ≤1:400 2. Submit complete PA request

How to Get Turalio (Pexidartinib) Covered by Blue Cross Blue Shield of Texas: Prior Authorization Guide and Appeal Process

Answer Box: Fastest Path to Approval Turalio (pexidartinib) is covered by Blue Cross Blue Shield of Texas for TGCT but requires prior authorization, REMS enrollment, and specialty pharmacy dispensing. The fastest path: (1) Ensure your prescriber and you complete REMS enrollment at TURALIOREMS.com, (2) Have your provider submit a

How to Get Carbaglu (Carglumic Acid) Covered by Cigna in Texas: Decision Tree, Appeals, and Next Steps

Answer Box: Getting Carbaglu Covered by Cigna in Texas Most likely to get approved: Confirmed NAGS deficiency with documented hyperammonemia, prescribed by a metabolic specialist, with protein-restricted diet. Fastest path: Have your metabolic specialist submit prior authorization with genetic testing results, ammonia levels, and treatment plan. First step today: Call

How to Get Uplizna (Inebilizumab) Covered by Cigna in Texas: Complete Guide to Prior Authorization, Appeals, and Approval Strategies

Answer Box: Getting Uplizna (Inebilizumab) Covered by Cigna in Texas Uplizna (inebilizumab) requires prior authorization from Cigna and is typically covered for AQP4-positive NMOSD when prescribed by a neurologist with documented step therapy. Your fastest path: (1) Have your neurologist submit a prior authorization through CoverMyMeds or Cigna's

How to Get Humate-P Covered by Humana in Texas: Prior Authorization, Appeals, and Financial Assistance

Answer Box: Getting Humate-P Covered by Humana in Texas Humana requires prior authorization for Humate-P (antihemophilic factor/vWF complex), typically with step therapy requiring trials of preferred alternatives first. In Texas, patients have 180 days to file internal appeals and can request independent external review through the Texas Department of

How to Get Krystexxa (Pegloticase) Covered by UnitedHealthcare in Texas: Complete Timeline and Appeals Guide

Answer Box: Getting Krystexxa Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Krystexxa (pegloticase) with strict step therapy and documentation requirements. The standard approval timeline is 15 days for complete submissions, with expedited reviews decided within 24 hours for urgent cases. To start: gather evidence of failed allopurinol

Getting Pomalyst (Pomalidomide) Covered by Cigna in Texas: Prior Authorization, Appeals, and State Protection Guide

Answer Box: Your Fastest Path to Coverage Getting Pomalyst (pomalidomide) covered by Cigna in Texas requires prior authorization with proof of multiple myeloma diagnosis, failure of lenalidomide and a proteasome inhibitor, and REMS enrollment. If denied, you have 180 days to appeal internally, then can request Texas Independent Review Organization

How to Get HyperHEP Covered by Blue Cross Blue Shield of Texas: Forms, Appeals & Contact Guide 2025

Answer Box: Getting HyperHEP Covered by BCBS Texas Quick Path to Coverage: Most Blue Cross Blue Shield of Texas (BCBSTX) plans cover HyperHEP (hepatitis B immune globulin) for post-exposure prophylaxis when administered within 24 hours of exposure. HealthSelect members need no prior authorization as of September 2024, but require a