Topic

Translarna (ataluren)

A collection of 25 issues

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)

How to Get Translarna (Ataluren) Covered by Aetna CVS Health in Texas: Prior Authorization Guide and Appeal Process

Quick Answer: Getting Translarna (Ataluren) Covered in Texas To get Translarna (ataluren) covered by Aetna CVS Health in Texas, you'll need prior authorization due to its specialty status and high cost. Start by having your prescriber submit a prior authorization request through CVS Caremark's system, including

How to Get Translarna (Ataluren) Covered by Cigna in California: Complete Prior Authorization Guide

Answer Box: Getting Translarna (Ataluren) Covered by Cigna in California Translarna (ataluren) is not FDA-approved but may be available through expanded access programs. For Cigna coverage in California: (1) Submit prior authorization via Cigna's California-specific form to fax 1-866-873-8279, (2) Include genetic testing confirming nonsense mutation DMD and

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

Answer Box: Getting Translarna Coverage in Texas Translarna (ataluren) is not FDA-approved and therefore not covered by Blue Cross Blue Shield of Texas as of 2024. However, if FDA approval occurs, coverage will require: (1) genetic confirmation of nonsense mutation DMD, (2) prior authorization through BCBS provider portal, and (3)

Humana's Coverage Criteria for Translarna (Ataluren) in Texas: Complete Guide to Medical Necessity and Appeals

Answer Box: Getting Translarna (Ataluren) Covered by Humana in Texas Current Status: Translarna is not yet FDA-approved in the US (pending 2024 NDA review). For Texas residents with Humana coverage: 1. Monitor FDA approval status - PTC Therapeutics resubmitted their application in late 2024 2. Prepare documentation now - genetic