Topic

California

A collection of 402 issues

How to Get Carbaglu (Carglumic Acid) Covered by Humana in California: Complete PA Guide with Appeals Process

Answer Box: Getting Carbaglu Covered by Humana in California Fastest Path to Approval: Submit prior authorization with confirmed NAGS deficiency diagnosis (ICD-10: E72.2), ammonia levels, and genetic/enzymatic testing results. Use HCPCS J7518 for billing (100mg units). If denied, file internal appeal within 65 days, then request California Independent

UnitedHealthcare's Coverage Criteria for Kuvan (Sapropterin) in California: Complete Prior Authorization Guide 2025

Answer Box: Getting Kuvan Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Kuvan (sapropterin dihydrochloride) with specific criteria: confirmed PKU diagnosis, active phenylalanine-restricted diet, and no concurrent Palynziq use. Submit through the UnitedHealthcare Provider Portal or call 866-889-8054. If denied, California residents can file a free Independent Medical

How to Get Ferriprox (Deferiprone) Covered by Aetna CVS Health in California: Prior Authorization Appeals Guide 2025

Answer Box: Getting Ferriprox Covered by Aetna CVS Health in California Fastest path to approval: Submit prior authorization with documented ferritin >1,000 mcg/L, ANC monitoring plan, and diagnosis of transfusional iron overload from thalassemia or sickle cell disease. If denied, file internal appeal within 60 days, then

Lowering Out-of-Pocket Costs for Tepezza (teprotumumab) with Blue Cross Blue Shield in California: Copay Cards, Appeals, and Financial Assistance

Answer Box: Getting Tepezza Covered at Lower Cost Blue Cross Blue Shield California requires prior authorization for Tepezza (teprotumumab), but multiple cost-reduction strategies can help. The medication must be prescribed by an endocrinologist or ophthalmologist, with documented thyroid levels within 50% of normal limits. Fastest path: 1) Apply for Amgen&

How to Get Rystiggo (rozanolixizumab-noli) Covered by Humana in California: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Rystiggo Covered by Humana in California Eligibility: Adults with generalized myasthenia gravis who are AChR- or MuSK-antibody positive. Fastest approval path: Submit prior authorization with antibody test results, MG-ADL scores, and documented failure/intolerance of standard therapies (AChEIs, steroids, IVIg/PLEX). First step today: Call Humana at

How to Get Palynziq (pegvaliase-pqpz) Covered by Humana in California: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Palynziq Covered by Humana in California Fastest Path: Submit prior authorization through your PKU specialist with blood phenylalanine levels >600 µmol/L, documented sapropterin failure, and REMS enrollment. If denied, file internal appeal within 65 days, then request California Independent Medical Review (IMR) through DMHC with

How Long Does It Take to Get Emflaza (deflazacort) Approved by UnitedHealthcare in California? Complete Timeline & Appeals Guide

Answer Box: Getting Emflaza Approved by UnitedHealthcare in California Timeline: 7-14 days for standard prior authorization, 2-3 days for expedited requests. Requirements: DMD diagnosis and documented failure/intolerance to prednisone or prednisolone (step therapy). First step: Have your neurologist submit prior authorization through the UnitedHealthcare provider portal with complete DMD

How to Get Raxone (idebenone) Covered by Blue Cross Blue Shield in California: Complete Prior Authorization and Appeals Guide

Answer Box: Raxone Coverage with Blue Cross Blue Shield in California Getting Raxone (idebenone) covered by Blue Cross Blue Shield in California requires prior authorization due to its limited FDA approval and specialty drug status. Your fastest path: (1) Have your physician submit a prior authorization request with genetic testing

Work With Your Doctor to Get Epidiolex (Cannabidiol) Covered by Aetna CVS Health in California: Complete Prior Authorization Guide

Quick Answer: Getting Epidiolex Covered by Aetna CVS Health in California Epidiolex requires prior authorization through Aetna CVS Health for seizures in Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex. Your neurologist must submit documentation showing failed trials of other anti-seizure medications. If denied, you can appeal within 180 days

Renewing Crysvita (Burosumab) Approval with Humana in California: Timeline, Documentation, and Appeals

Answer Box: Renewing Crysvita (Burosumab) with Humana in California Fastest path to renewal: Start 60 days before your current authorization expires. Submit lab results showing serum phosphorus response, clinical notes documenting symptom improvement, and adherence records through your provider's Humana portal. If denied, file an internal appeal within