Topic

California

A collection of 516 issues

How to Get Exondys 51 (Eteplirsen) Covered by Aetna CVS Health in California: Prior Authorization Guide and Appeals Process

Answer Box: Fast Track to Approval To get Exondys 51 (eteplirsen) covered by Aetna CVS Health in California: Submit prior authorization with genetic testing confirming exon 51 amenable DMD mutation, specialist prescription, baseline functional assessments (6-minute walk test ≥300m), and corticosteroid trial documentation. If denied, file internal appeal within 21
6 min read

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

Answer Box: Getting Tagrisso (osimertinib) Covered by Humana in California Humana requires prior authorization for Tagrisso (osimertinib) with documented EGFR mutation testing and clinical justification. The fastest path: have your oncologist submit a complete prior authorization request through Humana's provider portal with EGFR test results, treatment history, and
7 min read

How to Get Oxlumo (Lumasiran) Covered by UnitedHealthcare in California: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Oxlumo Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Oxlumo (lumasiran) to treat primary hyperoxaluria type 1 (PH1) in California, with no step therapy required. You need genetic testing confirming AGXT mutations, baseline urinary oxalate levels, and a specialist prescriber (nephrologist/geneticist/urologist). Fastest approval
6 min read

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

Answer Box: Getting Aldurazyme Coverage in California Blue Shield of California covers Aldurazyme (laronidase) as a specialty drug requiring prior authorization for MPS I patients. The fastest path to approval: (1) Gather genetic/enzymatic confirmation of MPS I diagnosis, (2) Document baseline disease severity and prior treatment failures, (3) Submit
6 min read

Myths vs. Facts: Getting Somatuline Depot (Lanreotide) Covered by Aetna CVS Health in California

Answer Box: Getting Somatuline Depot Covered by Aetna CVS Health in California Aetna CVS Health requires prior authorization for Somatuline Depot (lanreotide) with specific criteria for acromegaly, GEP-NETs, and carcinoid syndrome. Key requirements include elevated IGF-1 levels, endocrinologist/oncologist prescription, and often prior octreotide trial. Fastest path: Submit complete PA
5 min read

How to Get Cresemba (Isavuconazole) Covered by Blue Cross Blue Shield in California: Prior Authorization Forms, Appeals & Timelines

Answer Box: Getting Cresemba Covered by Blue Cross Blue Shield in California Blue Cross Blue Shield California requires prior authorization for all Cresemba (isavuconazole) requests. Submit clinical documentation showing confirmed invasive aspergillosis or mucormycosis (ICD-10 codes B46.0-B46.9) via AuthAccel portal or fax. If denied, file an internal appeal
6 min read

How to Get Kymriah (tisagenlecleucel) Covered by Blue Shield of California: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Kymriah Covered by Blue Shield of California Blue Shield of California covers Kymriah (tisagenlecleucel) for eligible patients with relapsed/refractory B-cell ALL and lymphomas, requiring prior authorization with medical records submission. To get approved: (1) Ensure you meet the medical necessity criteria including CD19-positive disease and 2+
7 min read