Topic

Texas

A collection of 386 issues

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

Answer Box: Getting Eloctate Approved by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Eloctate (efmoroctocog alfa) in Texas, typically with step therapy requiring trial of preferred factor VIII products first. Fastest approval path: Have your hematologist submit PA with confirmed hemophilia A diagnosis, documented failure/intolerance of preferred alternatives,

How to Get Krystexxa (Pegloticase) Approved by Humana in Texas: Complete Prior Authorization Guide

Answer Box: Getting Krystexxa Approved by Humana in Texas Timeline: Humana decides standard prior authorizations within 14 days (moving to 7 days by 2026), with expedited decisions in 72 hours when medically urgent. Key requirements: documented failure of allopurinol/febuxostat, G6PD testing, rheumatologist prescription, and often methotrexate co-therapy. First step:

Getting Raxone (Idebenone) Covered by Cigna in Texas: Prior Authorization, Appeals, and Formulary Exception Guide

Answer Box: How to Get Raxone (Idebenone) Covered by Cigna in Texas Raxone (idebenone) requires a formulary exception from Cigna in Texas since it's not FDA-approved for LHON. Your prescriber must submit the Texas Standard Prior Authorization Request Form with genetic testing confirming LHON, visual field studies, and

Myths vs. Facts: Getting Bavencio (avelumab) Covered by UnitedHealthcare in Texas - Complete Prior Authorization Guide

Answer Box: Getting Bavencio Covered by UnitedHealthcare in Texas Eligibility: Bavencio requires prior authorization from UnitedHealthcare for metastatic Merkel cell carcinoma and maintenance urothelial carcinoma treatment. Fastest path: Submit PA through the UnitedHealthcare Provider Portal with complete pathology reports, staging studies, and treatment history. First step today: Verify your plan

How to Get Ofev (nintedanib) Covered by Cigna in Texas: Prior Authorization Guide and Appeal Strategies

Answer Box: Getting Ofev (nintedanib) Covered by Cigna in Texas Quick Path to Approval: Cigna requires prior authorization for Ofev (nintedanib) with specific diagnostic and clinical criteria. Your pulmonologist must submit documentation showing confirmed IPF or progressive fibrosing ILD via high-resolution CT, pulmonary function tests meeting minimum thresholds (typically FVC

Lowering Out-of-Pocket Costs for Sumavel DosePro with UnitedHealthcare in Texas: Coverage, Copays & Patient Assistance

Quick Answer: Sumavel DosePro (needle-free sumatriptan injection) was discontinued in the U.S., so UnitedHealthcare now covers generic sumatriptan injection alternatives. Most plans require prior authorization and step therapy through oral triptans first. In Texas, you have 180 days to appeal denials internally, plus external review rights through an Independent

How to Get Kesimpta (Ofatumumab) Covered by Aetna CVS Health in Texas: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Kesimpta Covered by Aetna CVS Health in Texas Fastest path to approval: Submit prior authorization through CVS Caremark with complete MS diagnosis documentation (ICD-10 G35), evidence of relapsing disease, and prescriber specialty verification. If denied, you have 4 years to appeal in Texas—much longer than the

Getting Lumizyme (Alglucosidase Alfa) Approved by Cigna in Texas: A Real Patient's Journey From Denial to Coverage

Answer Box: Getting Lumizyme Covered by Cigna in Texas Fastest path to approval: Submit prior authorization with enzyme deficiency confirmation, genetic testing results, and specialist prescription through Cigna's provider portal. Key requirements: GAA enzyme activity testing, genetic confirmation, and prescription by metabolic specialist or neurologist experienced with lysosomal

Renewing Myozyme (Alglucosidase Alfa) Approval with Cigna in Texas: Complete 2025 Guide

Answer Box: Renewing Myozyme Coverage with Cigna in Texas Cigna requires annual prior authorization renewal for Myozyme (alglucosidase alfa) through Express Scripts/Accredo specialty pharmacy. Start your renewal 30-45 days before expiration to avoid coverage gaps. Submit updated clinical documentation showing treatment response, specialist oversight, and continued medical necessity via

How to Get Epidiolex (Cannabidiol) Covered by Blue Cross Blue Shield of Texas: PA Requirements, Appeals Process & Forms

Quick Answer: Getting Epidiolex Covered by BCBS Texas Epidiolex is covered by Blue Cross Blue Shield of Texas but requires prior authorization for seizures associated with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex. To get approved: (1) Confirm your diagnosis matches one of these three FDA-approved conditions, (2) document