Topic

Trikafta (elexacaftor/tezacaftor/ivacaftor)

A collection of 25 issues

How to Get Trikafta Covered by Cigna in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Trikafta Coverage To get Trikafta covered by Cigna in Ohio: Submit prior authorization with CFTR genotype documentation (F508del mutation), baseline liver function tests, and prescription from a CF specialist. If denied, file internal appeal within 180 days, then external review through Ohio Department of Insurance.

Getting Trikafta Approved by Humana in North Carolina: Complete Coverage Guide with Appeals Process

Quick Answer: Do You Qualify for Trikafta Coverage by Humana in North Carolina? Most likely yes, if you have: Confirmed cystic fibrosis with at least one F508del CFTR mutation (or other responsive mutation), age 2+, and recent liver function tests. Fastest path: Your CF specialist submits prior authorization with genetic

How to Get Trikafta Covered by UnitedHealthcare in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Trikafta Covered by UnitedHealthcare in Virginia To get Trikafta (elexacaftor/tezacaftor/ivacaftor) covered by UnitedHealthcare in Virginia, you need prior authorization with documented CFTR genotype testing showing responsive mutations, baseline liver function tests, and confirmed cystic fibrosis diagnosis. If denied, Virginia offers a robust external review process

How to Get Trikafta Covered by Cigna in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Trikafta Covered by Cigna in New York Cigna requires prior authorization for Trikafta (elexacaftor/tezacaftor/ivacaftor) in New York. Approval depends on confirmed cystic fibrosis diagnosis with documented CFTR mutation (especially F508del), prescription by a CF specialist, and complete clinical documentation. If denied, New York's

Renewing Trikafta Coverage with Aetna CVS Health in Pennsylvania: Complete 2025 Guide

Answer Box: Renewing Trikafta Coverage with Aetna CVS Health Trikafta renewals with Aetna CVS Health require annual reauthorization 30-60 days before expiration. You'll need updated clinical documentation showing treatment benefit (stable/improved FEV1, reduced exacerbations), current liver function tests, and confirmation from your CF specialist. Submit renewal requests

How to Get Trikafta Covered by Aetna CVS Health in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Trikafta Covered by Aetna CVS Health in Illinois Trikafta requires prior authorization from Aetna CVS Health with documented CFTR genotype testing showing eligible mutations (like F508del), cystic fibrosis diagnosis, and baseline labs. If denied, you have 180 days to appeal internally, then 4 months for Illinois external

Getting Trikafta Approved by Aetna CVS Health in California: Complete Prior Authorization and Appeals Guide 2024

Answer Box: Getting Trikafta Covered by Aetna CVS Health in California Trikafta requires prior authorization from Aetna CVS Health. Submit documentation including CFTR genotype test results, cystic fibrosis diagnosis (ICD-10: E84.0-E84.9), and clinical notes. If denied, file an internal appeal within 180 days, then request California's

Getting Trikafta Covered by Humana in Pennsylvania: Prior Authorization, Appeals, and Coding Guide

Answer Box: Fast Track to Trikafta Coverage Trikafta requires prior authorization from Humana Medicare in Pennsylvania. Submit CFTR genotype documentation (F508del or other responsive mutations), current liver function tests, and ICD-10 code E84.0-E84.9 for cystic fibrosis. Humana decides within 7 days for standard requests, 72 hours for expedited.

How to Get Trikafta Covered by UnitedHealthcare in New York: Prior Authorization, Appeals & Specialty Pharmacy Guide

Answer Box: Getting Trikafta Covered by UnitedHealthcare in New York Trikafta requires prior authorization from UnitedHealthcare and must be filled through an approved specialty pharmacy like Optum Specialty Pharmacy. The drug is placed on Tier 3 (specialty tier) with the highest cost-sharing. To get approved: (1) Your doctor submits a

How to Get Trikafta Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Trikafta Covered in Washington Trikafta requires prior authorization from Blue Cross Blue Shield plans in Washington (Premera, Regence). The fastest path: (1) Confirm your CFTR genotype documentation with F508del mutation, (2) Have your CF specialist submit PA with baseline labs and pulmonary function tests, (3) Ensure prescription