Topic

California

A collection of 492 issues

How Long Does It Take to Get Amvuttra (vutrisiran) Approved by Cigna in California? Complete Timeline Guide

Answer Box: Fastest Path to Amvuttra (vutrisiran) Approval Getting Amvuttra (vutrisiran) covered by Cigna in California typically takes 72 hours for complete submissions, or 24 hours for urgent cases. You'll need genetic testing confirming a TTR pathogenic variant, documented polyneuropathy (hATTR-PN) or cardiomyopathy (ATTR-CM), and may face step

UnitedHealthcare's Coverage Criteria for Tremfya in California: What Counts as "Medically Necessary"?

Answer Box: Getting Tremfya Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Tremfya (guselkumab) with step therapy through TNF inhibitors first, documented disease severity (PASI ≥12 or BSA ≥10%), and negative TB screening within 12 months. If denied, California's Independent Medical Review (IMR) has a 73%

How to Get Brineura (cerliponase alfa) Covered by Humana in California: PA Forms, Appeals, and Exception Paths

Quick Answer: Getting Brineura Covered by Humana in California Brineura (cerliponase alfa) requires prior authorization from Humana for pediatric CLN2 patients ≥3 years. Submit Humana's "Request for Medicare Prescription Drug Coverage Determination" with prescriber documentation proving CLN2 diagnosis, specialized center capability, and medical necessity. Standard decisions

How Long Does It Take to Get Crysvita (burosumab) Approved by Aetna CVS Health in California? Complete Timeline Guide

Quick Answer: Crysvita Approval Timeline with Aetna CVS Health in California Standard approval takes 30-45 days through CVS Specialty Pharmacy's prior authorization process. Expedited review (72 hours) is available if delays would jeopardize your health. California residents have strong appeal rights through the DMHC Independent Medical Review process,

How to Get Luxturna (voretigene neparvovec-rzyl) Covered by Blue Cross Blue Shield California: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Luxturna Covered in California Blue Shield of California requires prior authorization for Luxturna (voretigene neparvovec-rzyl) with specific criteria: confirmed biallelic RPE65 mutation via genetic testing, documented viable retinal cells, and no prior gene therapy. Submit clinical documentation via fax for review. If denied, file an internal appeal

Work With Your Doctor to Get Entresto (sacubitril/valsartan) Approved by Cigna in California

Answer Box: Getting Entresto (sacubitril/valsartan) Covered by Cigna in California Cigna requires prior authorization for Entresto with step therapy—you must try generic sacubitril-valsartan first. Your cardiologist needs to document heart failure with reduced ejection fraction (LVEF ≤40%) and prior ACE inhibitor or ARB failure/intolerance. If denied, California&

How to Get Ozempic and Mounjaro Covered by Humana in California: Prior Authorization Forms, Appeal Deadlines, and State Protections

Answer Box: Getting Ozempic/Mounjaro Covered by Humana in California Humana Medicare Advantage plans in California typically require prior authorization for Ozempic (semaglutide) and Mounjaro (tirzepatide), with both drugs listed as Tier 3-5 specialty medications. Most denials stem from step therapy requirements or lack of diabetes diagnosis documentation. Your fastest

The Complete Checklist to Get Crysvita (Burosumab) Covered by Cigna in California: Forms, Appeals, and Requirements

Answer Box: Fastest Path to Approval Getting Crysvita (burosumab) covered by Cigna in California requires prior authorization through Express Scripts/Accredo with specific documentation: confirmed XLH diagnosis (PHEX gene mutation or elevated FGF23), baseline low serum phosphorus, endocrinologist prescription, and failed oral phosphate therapy. First step today: Have your specialist

How to Get Evrysdi (Risdiplam) Covered by Cigna in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Evrysdi Covered by Cigna in California Yes, Cigna covers Evrysdi (risdiplam) with prior authorization. You need genetic confirmation of SMA (SMN1 mutations), baseline motor assessment scores, and prescription by a neuromuscular specialist. Fastest path: Have your neurologist submit the completed Cigna Evrysdi PA form with genetic test

How to Get Stelara (ustekinumab) Covered by Aetna (CVS Health) in California: Prior Authorization, Appeals, and Alternative Options

Quick Answer: Getting Stelara Covered by Aetna in California Aetna (CVS Health) requires prior authorization for Stelara (ustekinumab) with step therapy requirements varying by indication. In California, you have strong appeal rights through the Department of Managed Health Care (DMHC) if denied. First step: Call Aetna at 1-888-632-3862 to confirm