By Counterforce Health Team in Givlaari (givosiran) —

Resources to Get Givlaari (givosiran) Approved with Cigna in California: Forms, Portals & Contacts

Answer Box: Getting Givlaari (givosiran) Covered by Cigna in California

Fastest path to approval: Submit Cigna's current Givlaari-specific PA form via CoverMyMeds portal with biochemical confirmation (elevated ALA/PBG), attack history, and specialist documentation. If denied, file internal appeal within 180 days, then request California DMHC Independent Medical Review (73% success rate). First step today: Download the current PA form, gather labs showing elevated urinary ALA or PBG, and document recent attacks requiring ER/hospital care or IV hemin.

Table of Contents

  1. Start Here: Verify Your Plan & Find the Correct Forms
  2. Forms: Current PA Request & Exception Forms
  3. Submission Portals: Where & How to Submit
  4. Fax & Mail: Contact Numbers & Addresses
  5. Specialty Pharmacy: Accredo Onboarding & Transfer
  6. Support Lines: Member, Provider & Case Management
  7. California Regulator & Consumer Assistance
  8. Update Cadence: Keeping Resources Current

Start Here: Verify Your Plan & Find the Correct Forms

Before diving into forms and portals, confirm your specific Cigna plan type, as requirements vary:

Check your ID card for:

  • Plan name (Cigna Healthcare, Cigna + Oscar, Medicare Advantage)
  • Group number and member ID
  • Pharmacy benefit administrator (often Express Scripts)
  • Provider services phone number

California plan types:

Tip: If you're unsure about your plan type, call the member services number on your ID card before proceeding with forms.

Forms: Current PA Request & Exception Forms

Givlaari Prior Authorization Form

Current form (2024): Cigna Givlaari CCRD Prior Authorization Form (revision v010124, dated 12/26/2023)

Required information:

  • Member details: Cigna ID, DOB, contact info
  • Prescriber: NPI/DEA, address, phone/fax, specialty
  • Urgency: Standard or Urgent (urgent = may seriously jeopardize life/health)
  • Drug specifics: Givlaari 189 mg/mL vial, ICD-10, dosing, patient weight
  • Site of fill options:
    • Accredo Specialty Pharmacy (Cigna's nationally preferred)
    • PANTHERx Specialty Pharmacy
    • Other (specify)

Clinical Documentation Requirements

For initial approval:

  1. Confirmed AHP diagnosis with clinical features (neurovisceral symptoms)
  2. Biochemical confirmation: Elevated urinary ALA or urinary/plasma PBG above normal
  3. Attack history: At least one porphyria attack in past 6 months requiring ER/hospital care or IV hemin
  4. Specialist involvement: Evaluation by or consultation with AHP-experienced specialist

For continuation:

  • Document beneficial response: reduced attack frequency, improved symptoms, decreased hemin use
  • Ongoing specialist oversight
  • Acceptable safety profile

Formulary Exception/Step Therapy Override

If Givlaari is non-formulary or requires step therapy, use:

Exception criteria:

  • Previous formulary/step therapy drugs were detrimental or ineffective
  • Requested drug is medically necessary and appropriate for the rare condition

Submission Portals: Where & How to Submit

Electronic Submission (Preferred)

Primary portal: CoverMyMeds Cigna page

  • Fastest processing
  • Real-time status updates
  • Automatic routing to Cigna/Express Scripts

Alternative: SureScripts via EHR

  • Direct integration from electronic health records
  • Reduces manual data entry

eviCore platform: For some Cigna/Express Scripts plans, pharmacy PAs route through eviCore by Evernorth under "Pharmacy Drugs (Express Scripts Coverage)"

Required Uploads

When submitting electronically, attach:

  • Completed PA form (PDF)
  • Lab reports showing elevated ALA/PBG with reference ranges
  • Attack history documentation (ER records, discharge summaries)
  • Specialist consultation notes
  • Prior therapy documentation (if applicable)
Note: Standard response time is 5 business days. Mark urgent requests when delay could seriously jeopardize health and call to expedite.

Fax & Mail: Contact Numbers & Addresses

General Customer Service

Phone: 1-800-997-1654 (24/7/365) TTY/TDD: Dial 711 Mail:

Cigna Healthcare
Attn: Customer Service
P.O. Box 20002
Nashville, TN 37202

Provider Services

Phone: 1-800-882-4462 (1-800-88-CIGNA)

  • Use for credentialing, PA status, benefit verification
  • Ask to be connected to pharmacy/specialty pharmacy services for Givlaari-related inquiries

Specialty Pharmacy (Accredo)

Ordering with Accredo:

  • E-prescribe: Accredo (1620 Century Center Pkwy, Memphis, TN 38134-8822 | NCPDP 4436920)
  • Fax: 888-302-1028
  • Phone: 866-759-1557
Important: Fax numbers for clinical documentation and appeals are typically plan-specific and provided on denial letters or PA forms. Always use the most current fax from official Cigna correspondence.

Specialty Pharmacy: Accredo Onboarding & Transfer

Accredo Setup Process

  1. Prescription routing: Provider sends prescription to Accredo via e-prescribe or fax
  2. PA coordination: Accredo assists with prior authorization submission if needed
  3. Benefit verification: Accredo verifies coverage and copay
  4. Patient enrollment: Patient completes Accredo enrollment forms
  5. Delivery coordination: Monthly shipments to patient or clinic

Transfer from Another Specialty Pharmacy

Required information:

  • Current specialty pharmacy name and phone
  • Prescription number and remaining refills
  • Preferred delivery address
  • Insurance information

Timeline: Transfers typically take 3-5 business days once all information is verified

Home vs. Clinic Delivery

Check your plan: Some Cigna plans require provider-administered "buy and bill" under medical benefit and exclude home delivery. Verify with member services before assuming home shipment is available.

Support Lines: Member, Provider & Case Management

Member Services

Primary contact: Number on back of ID card or 1-800-997-1654

What to ask for:

  • "Prior authorization status for Givlaari"
  • "Specialty pharmacy benefits"
  • "Case management for rare disease"
  • "Appeals department" (if denied)

Provider Support

Main line: 1-800-882-4462

Escalation options:

  • Request peer-to-peer review with Cigna medical director
  • Ask for case manager assignment for complex rare disease cases
  • Request expedited review for urgent situations

Case Management Access

For members: Call customer service and ask for "case management" or "care management" Health Advocate line: 1-855-673-3063 for help deciding care needs

For providers: Call provider services and request connection to member's case management team for care coordination

Tip: Case managers can help navigate complex approval processes for rare diseases and coordinate with specialty pharmacy.

California Regulator & Consumer Assistance

DMHC Independent Medical Review (IMR)

If Cigna denies coverage after internal appeals, California residents can request an Independent Medical Review through the Department of Managed Health Care.

Eligibility:

  • Plan is DMHC-regulated (most HMOs and managed care plans)
  • Service denied as not medically necessary, experimental, or investigational
  • Internal appeal completed or 30 days passed without resolution

How to file:

Timeline:

  • Standard IMR: 45 days after application accepted
  • Expedited IMR: 3-7 days for urgent situations

Success rate: Approximately 73% of IMR cases result in overturning the health plan's denial

Consumer Assistance

DMHC Help Center: 1-888-466-2219

  • Free assistance filing complaints and IMRs
  • Available 24/7 for urgent issues
  • Multilingual support

Health Consumer Alliance: Nonprofit providing free help with insurance appeals and complex cases

Note: No fee to request an IMR in California; insurers bear the cost of review.

Update Cadence: Keeping Resources Current

Quarterly Checks (Every 3 Months)

Forms updates:

Portal access:

  • Confirm CoverMyMeds and SureScripts integration status
  • Test portal functionality if experiencing submission issues

Annual Reviews (January)

Policy changes:

  • Review updated Cigna coverage policies for givosiran
  • Check for new medical necessity criteria
  • Verify formulary status and tier placement

Contact information:

  • Confirm phone numbers on ID cards
  • Update provider contact lists
  • Verify specialty pharmacy network changes

When to Re-verify Immediately

  • After plan renewal or change
  • Following denial or coverage issues
  • When switching between standard and expedited processes
  • After regulatory changes in California

Frequently Asked Questions

How long does Cigna PA take for Givlaari in California? Standard review is 5 business days; expedited review within 24-72 hours if marked urgent with physician attestation.

What if Givlaari is non-formulary on my Cigna plan? Request a formulary exception using the appropriate form, documenting medical necessity and why formulary alternatives are inappropriate.

Can I request an expedited appeal in California? Yes, if delay could seriously jeopardize life, health, or ability to function. Mark appeals as urgent and have physician provide supporting documentation.

Does step therapy apply if I failed treatments outside California? Yes, document prior treatment failures from any location. Cigna accepts out-of-state treatment history with proper documentation.

What counts as biochemical confirmation for AHP? Elevated urinary ALA or urinary/plasma PBG above the lab's upper limit of normal, with specific values and reference ranges documented.

About Counterforce Health

Counterforce Health helps patients, clinicians, and specialty pharmacies turn insurance denials into successful appeals through evidence-backed, targeted rebuttals. Our platform analyzes denial letters, identifies the specific denial basis, and creates point-by-point appeals aligned to each payer's own rules, dramatically improving approval rates for complex specialty medications like Givlaari.

Sources & Further Reading

This guide is for informational purposes only and does not constitute medical advice. Always consult with your healthcare provider about treatment decisions. For assistance with appeals and coverage issues, contact Counterforce Health or the California DMHC Help Center at 1-888-466-2219.

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