Topic

California

A collection of 402 issues

Myths vs. Facts: Getting Naglazyme (galsulfase) Covered by UnitedHealthcare in California

Answer Box: Fast Facts for California Patients UnitedHealthcare requires prior authorization for Naglazyme (galsulfase) in California. Success depends on complete diagnostic documentation (enzyme assay + genetic testing), specialist involvement, and baseline functional assessments. If denied, California's Independent Medical Review (IMR) overturns 55-70% of medical necessity denials. First step: Have

How to Get iLink® Corneal Cross-Linking Covered by Humana in California: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting iLink® Covered by Humana in California Yes, Humana generally covers iLink® corneal cross-linking for progressive keratoconus when medical necessity criteria are met. The fastest path to approval: 1) Verify your ophthalmologist and facility are in-network, 2) Submit prior authorization with documented progression over 12 months (≥1.0

Work With Your Doctor to Get Ilaris (Canakinumab) Covered by Cigna in California

Answer Box: Getting Ilaris (Canakinumab) Covered by Cigna in California To get Ilaris covered by Cigna in California, you'll need to work closely with your rheumatologist to document medical necessity under Cigna's IP0235 policy. The fastest path: (1) Gather your complete treatment history and current lab

How to Get Kuvan (Sapropterin) Covered by Cigna in California: Prior Authorization Guide and Appeal Process

Quick Answer: Getting Kuvan Covered by Cigna in California Most likely eligible if: You have confirmed PKU, elevated phenylalanine levels despite dietary management, and specialist oversight. Fastest path: Have your metabolic specialist submit prior authorization through Cigna's provider portal with complete PKU documentation. First step today: Call Cigna

How to Get Elaprase (Idursulfase) Covered by Humana in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Elaprase Covered by Humana in California Elaprase (idursulfase) for Hunter syndrome typically requires prior authorization from Humana, with approval based on confirmed MPS II diagnosis, weight-based dosing (0.5 mg/kg weekly), and specialist prescribing. Start by having your doctor submit a PA request with genetic/enzymatic

How to Get Eylea and Lucentis Covered by UnitedHealthcare in California: Complete Prior Authorization and Appeal Guide

Quick Answer: UnitedHealthcare requires prior authorization for Eylea (aflibercept) and Lucentis (ranibizumab) in California. Submit requests through the UnitedHealthcare Provider Portal with OCT imaging, visual acuity measurements, and diagnosis documentation. If denied, file an internal appeal within 30 days, then request a California DMHC Independent Medical Review for binding external

Work With Your Doctor to Get Therakos CELLEX Photopheresis Approved by Aetna CVS Health in California

Answer Box: Your Path to Approval Getting Therakos CELLEX photopheresis covered by Aetna CVS Health in California requires strong physician partnership and detailed documentation. Start by scheduling a visit with your specialist to review your diagnosis (CTCL or steroid-refractory GVHD), document all failed prior treatments, and prepare a comprehensive medical

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.

Renewing Myozyme (Alglucosidase Alfa) Approval with Humana in California: Complete 2025 Guide

Answer Box: Getting Myozyme Renewal Approved Start 30-60 days early. Humana typically requires annual reauthorization for Myozyme (alglucosidase alfa) with updated clinical documentation showing ongoing benefit. Your prescriber must submit: confirmed Pompe diagnosis, recent specialist visit notes, objective response measures (6-minute walk, pulmonary function), current dosing, and safety data. If

How Long Does It Take to Get Krystexxa (Pegloticase) Approved by Blue Cross Blue Shield California? Complete Timeline & Appeal Guide

Answer Box: Fastest Path to Krystexxa Approval in California Getting Krystexxa (pegloticase) covered by Blue Cross Blue Shield California typically takes 5-14 business days for initial prior authorization, with yearly reauthorization required. The fastest approval path requires complete documentation of allopurinol/febuxostat failure, G6PD testing, and methotrexate co-therapy plans submitted