Topic

Translarna (ataluren)

A collection of 19 issues

Getting Translarna (Ataluren) Covered by Humana in Virginia: Prior Authorization Guide and Appeal Process

Answer Box: How to Get Translarna (Ataluren) Covered by Humana in Virginia Translarna (ataluren) requires prior authorization from Humana and is typically not on standard formularies. Your fastest path to coverage: 1. Confirm genetic testing shows nonsense mutation Duchenne muscular dystrophy (nmDMD) 2. Document corticosteroid trial/failure to meet step

How to Get Translarna (Ataluren) Covered by UnitedHealthcare in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Translarna Coverage Through UnitedHealthcare in Michigan Translarna (ataluren) is not FDA-approved and generally excluded by UnitedHealthcare, but coverage may be possible through formulary exceptions. Your fastest path: 1) Verify your plan type and referral needs via the member portal, 2) Have a neuromuscular specialist submit a comprehensive

Getting Translarna (Ataluren) Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Started with Translarna Coverage Blue Cross Blue Shield plans in New York typically require prior authorization for Translarna (ataluren) and often list it as non-formulary due to its regulatory status. Success depends on having complete genetic documentation (nonsense mutation DMD), ambulatory status confirmation, and specialist prescriber involvement.

How to Get Translarna (Ataluren) Covered by Blue Cross Blue Shield in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Translarna Covered in Georgia Translarna (ataluren) requires prior authorization from Blue Cross Blue Shield of Georgia (Anthem BCBS). The fastest path: (1) Confirm your genetic testing shows a nonsense mutation in the DMD gene, (2) Have your neurologist submit a comprehensive PA request through Anthem's

Do You Qualify for Translarna (Ataluren) Coverage by Aetna CVS Health in California? Decision Tree & Next Steps

Answer Box: Getting Translarna (Ataluren) Covered by Aetna CVS Health in California Important Update: Translarna (ataluren) is currently under FDA review with no approved status in the United States as of 2025. While the FDA accepted PTC Therapeutics' resubmitted application in November 2024, no decision timeline has been set.

How to Get Translarna (ataluren) Covered by UnitedHealthcare in Illinois: Coding, Appeals, and Prior Authorization Guide

Answer Box: Getting Translarna Covered by UnitedHealthcare in Illinois Fastest path to approval: Submit prior authorization through OptumRx with ICD-10 code G71.01, genetic testing confirming nonsense mutation DMD, and ambulatory status documentation. If denied, you have 180 days for internal appeals, then 30 days for Illinois external review. Start

Getting Translarna (Ataluren) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Fast Track to Translarna Coverage To get Translarna (ataluren) covered by Blue Cross Blue Shield in Washington, you need: 1. Genetic confirmation of nonsense mutation DMD via molecular testing 2. Ambulatory status documentation (6-minute walk test within 6 months) 3. Prior authorization submission through your BCBS provider portal

How to Get Translarna (Ataluren) Covered by Humana in New York: Timeline, Appeals & Required Documentation

Quick Answer: Getting Translarna (Ataluren) Covered by Humana in New York Timeline: 14 days for standard prior authorization (reducing to 7 days in 2026), 72 hours for urgent requests. Requirements: Genetic testing confirming nonsense mutation DMD, 6-minute walk test results, specialist prescription, and annual renewal documentation. First step: Contact your

Renewing Translarna (Ataluren) Coverage with Humana in California: 2025 Requirements and Timeline

Answer Box: Renewing Translarna (Ataluren) with Humana in California Renewal Timeline: Submit renewal requests 30-60 days before your current prior authorization expires to avoid coverage gaps. Humana requires updated clinical documentation showing continued ambulatory function and treatment response. Key Requirements: 6-minute walk test results, current clinical notes, adherence documentation, and

How to Get Translarna (Ataluren) Covered by Aetna CVS Health in Washington: Complete Appeals Guide with Forms and Timelines

Quick Answer: Translarna (ataluren) is typically excluded from Aetna's standard formularies, requiring a formulary exception request with detailed genetic testing documentation and clinical justification. In Washington, you have 60 days to file internal appeals and can request external review through the state's Independent Review Organization (IRO)