Topic

Texas

A collection of 49 issues

How to Get Tavalisse (Fostamatinib) Covered by Cigna in Texas: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Tavalisse Covered by Cigna in Texas Cigna covers Tavalisse (fostamatinib) for adults with chronic ITP after step therapy requirements are met. Your fastest path to approval: 1) Confirm you've tried required first-line treatments (steroids, IVIG, or TPO receptor agonists), 2) Have your hematologist submit a

UnitedHealthcare's Coverage Criteria for Evkeeza in Texas: What Counts as "Medically Necessary"?

Answer Box: Getting Evkeeza Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Evkeeza (evinacumab-dgnb) with strict medical necessity criteria. You'll need documented homozygous familial hypercholesterolemia (HoFH), genetic testing or LDL-C ≥300 mg/dL on maximally tolerated therapy, and evidence of failed standard treatments. First step: Have

How to Get Imbruvica (ibrutinib) Covered by Aetna CVS Health in Texas: Prior Authorization, Appeals, and Step-by-Step Guide

Answer Box: Getting Imbruvica Covered by Aetna CVS Health in Texas Imbruvica (ibrutinib) requires prior authorization from Aetna CVS Health but typically doesn't require step therapy for CLL/SLL or Waldenström macroglobulinemia. Your fastest path to approval: 1) Have your oncologist submit a prior authorization with diagnosis confirmation

How to Get Carbaglu (carglumic acid) Covered by Aetna (CVS Health) in Texas: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Carbaglu (carglumic acid) Covered by Aetna (CVS Health) in Texas Fastest path to approval: Aetna (CVS Health) requires prior authorization for Carbaglu with documented NAGS deficiency, elevated plasma ammonia levels, and genetic/biochemical testing. First step today: Have your prescriber submit a PA request via Aetna'

Myths vs. Facts: Getting Cabometyx (Cabozantinib) Covered by Aetna CVS Health in Texas

Answer Box: Getting Cabometyx Covered by Aetna CVS Health in Texas Eligibility: Cabometyx requires prior authorization for FDA-approved indications (renal cell carcinoma, hepatocellular carcinoma, differentiated thyroid cancer). Fastest path: Submit complete PA request through Availity portal with medical necessity letter, imaging with RECIST criteria, and prior therapy documentation. First step

How to Get Eloctate Covered by Blue Cross Blue Shield of Texas: Medical Necessity Criteria and Appeal Guide

Quick Answer: Blue Cross Blue Shield of Texas requires prior authorization for Eloctate (efmoroctocog alfa) and lists it as non-preferred, meaning you'll likely need to try preferred alternatives like Adynovate or Jivi first. To get coverage, your hematologist must document hemophilia A diagnosis, failed preferred therapies, and medical

Renewing Lutathera (Lutetium Lu-177 Dotatate) Approval with Aetna CVS Health in Texas: Timeline, Documents, and Bridge Options

Answer Box: Renewing Your Lutathera Approval Lutathera (lutetium Lu-177 dotatate) renewal with Aetna CVS Health in Texas requires documentation of continued clinical benefit before completing all 4 doses. Most patients receive initial approval for the full 4-dose course, but if treatment was interrupted or you need continuation authorization, submit clinical

How to Get Ibrance (Palbociclib) Covered by Humana in Texas: Prior Authorization Guide, Appeals Process & Forms

Quick Answer: Getting Ibrance Covered by Humana in Texas Ibrance (palbociclib) requires prior authorization from Humana but is covered on their Medicare Advantage formulary. Your fastest path to approval: have your oncologist submit comprehensive clinical documentation including HR+/HER2- pathology reports, treatment history, and medical necessity justification through CoverMyMeds or

How to Get Zolgensma Covered by Aetna in Texas: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Zolgensma Covered by Aetna in Texas Aetna requires prior authorization for Zolgensma (onasemnogene abeparvovec) in Texas. Your child must be under 2 years old with genetic confirmation of SMA (bi-allelic SMN1 mutations). The fastest path: 1) Have your neurologist submit prior authorization with genetic test results, 2)