Topic

California

A collection of 241 issues

How to Get Venclexta (Venetoclax) Covered by Blue Cross Blue Shield California: Prior Authorization, Appeals & Formulary Alternatives

Answer Box: Getting Venclexta Covered by Blue Cross Blue Shield California Venclexta (venetoclax) requires prior authorization from Blue Cross Blue Shield California for CLL/SLL and AML. Submit clinical documentation showing diagnosis, prior treatment failures, and medical necessity through your prescriber. If denied, California's Independent Medical Review (IMR)

How to Get Givlaari (givosiran) Covered by Humana in California: Complete Appeals Guide with Templates

Quick Answer: Getting Givlaari Approved by Humana in California Givlaari (givosiran) requires prior authorization from Humana, typically requiring documented acute hepatic porphyria (AHP) with elevated ALA/PBG levels, ≥2 attacks in 6 months, and specialist involvement. If denied, you have 65 days to appeal and can request California's

How to Get Kanuma (Sebelipase Alfa) Covered by UnitedHealthcare in California: Complete Guide to Prior Authorization, Appeals, and Cost Assistance

Quick Answer: Getting Kanuma Covered by UnitedHealthcare in California Eligibility: UnitedHealthcare covers Kanuma for confirmed lysosomal acid lipase deficiency (LAL-D) with prior authorization. Fastest path: Submit PA request through UnitedHealthcare provider portal with enzyme/genetic testing and clinical documentation. First step today: Gather LAL enzyme activity test results and contact

How to Get Defitelio (defibrotide) Covered by Blue Cross Blue Shield in California: PA Requirements, Appeals, and IMR Success Tips

Answer Box: Getting Defitelio Covered by Blue Cross Blue Shield in California Defitelio (defibrotide) requires prior authorization from Blue Cross Blue Shield in California and is covered only for FDA-approved use: treating hepatic veno-occlusive disease (VOD) with renal or pulmonary dysfunction after stem cell transplant. The fastest path to approval:

How to Get Ocrevus (Ocrelizumab) Covered by Humana in California: Complete Prior Authorization Guide

Quick Answer: Getting Ocrevus Covered by Humana in California Ocrevus (ocrelizumab) requires prior authorization from Humana and is subject to step therapy requirements. Most patients must first try and fail preferred MS medications before approval. Submit your PA request through Humana's provider portal with complete clinical documentation. If

How to Get Juxtapid (Lomitapide) Covered by UnitedHealthcare in California: Appeals, REMS Requirements, and Step Therapy Overrides

Answer Box: Getting Juxtapid Covered by UnitedHealthcare in California Eligibility: Juxtapid requires prior authorization from UnitedHealthcare for confirmed homozygous familial hypercholesterolemia (HoFH) with genetic testing or LDL-C ≥400 mg/dL, baseline liver function tests, and documented failure/intolerance of other lipid-lowering therapies. Fastest path: Submit prior authorization with HoFH genetic

How to Get Eylea and Lucentis Covered by Aetna CVS Health in California: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Eylea/Lucentis Covered by Aetna CVS Health in California To get Eylea (aflibercept) or Lucentis (ranibizumab) covered by Aetna CVS Health in California: First, ensure your ophthalmologist documents wet AMD, diabetic macular edema, or other FDA-approved diagnosis with OCT imaging and visual acuity measurements. Second, expect step

Do You Qualify for StrataGraft Coverage by Blue Cross Blue Shield in California? Decision Tree & Next Steps

Quick Answer: StrataGraft Coverage Eligibility You likely qualify for StrataGraft coverage if you're an adult with deep partial-thickness thermal burns where surgical intervention is clinically indicated. Blue Cross Blue Shield California requires prior authorization through your hospital's utilization management team using HCPCS code Q4199 (medical benefit,

How to Get Xenpozyme (olipudase alfa-rpcp) Covered by Aetna (CVS Health) in California: Appeals Guide & Templates

Answer Box: Getting Xenpozyme Covered by Aetna (CVS Health) in California Xenpozyme (olipudase alfa-rpcp) requires prior authorization from Aetna (CVS Health) in California. Your fastest path to approval: 1) Have your doctor submit a prior authorization request with ASMD diagnosis confirmation (enzyme assay and genetic testing), 2) Include documentation of

How to Get Firazyr (Icatibant) Covered by Aetna CVS Health in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Firazyr (Icatibant) Covered by Aetna CVS Health in California Firazyr (icatibant) is excluded from most Aetna CVS Health formularies in California, requiring a formulary exception and prior authorization for coverage. Your fastest path to approval: (1) Have an HAE specialist submit a formulary exception with documented HAE