Topic

California

A collection of 402 issues

Get Epidiolex (Cannabidiol) Covered by UnitedHealthcare in California: Prior Authorization Guide, Appeal Forms & Success Rates

Answer Box: Getting Epidiolex Covered by UnitedHealthcare in California Eligibility: Epidiolex requires prior authorization for Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex in patients 1+ years old. Fastest path: Submit PA through OptumRx with neurologist prescription, documented seizure syndrome diagnosis, and proof of 2+ failed antiseizure medications. Start today:
5 min read

How to Get Tavalisse (Fostamatinib) Covered by Blue Cross Blue Shield in California: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Getting Tavalisse Covered by Blue Cross Blue Shield in California Tavalisse (fostamatinib) is covered by Blue Shield of California as a specialty medication requiring prior authorization and specialty pharmacy dispensing. The fastest path to approval: 1) Have your hematologist submit a prior authorization request documenting failed first-line ITP
7 min read

How to Get Filsuvez (Birch Triterpenes) Covered by Blue Cross Blue Shield in California: Complete Appeal Guide 2025

Quick Answer: Getting Filsuvez Covered in California Filsuvez (birch triterpenes topical gel) requires prior authorization from Blue Cross Blue Shield in California. For patients with junctional or dystrophic epidermolysis bullosa, the fastest path to approval involves: 1) Having your dermatologist or EB specialist submit a detailed PA request with confirmed
7 min read

How to Get Ofev (Nintedanib) Covered by UnitedHealthcare in California: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Ofev Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Ofev (nintedanib) across all California plans, with strict clinical criteria including pulmonologist evaluation, HRCT confirmation of fibrosis, and documented disease progression. If denied, California's Independent Medical Review (IMR) system provides binding external review with
5 min read

How to Get Qalsody (Tofersen) Covered by UnitedHealthcare in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Qalsody Covered by UnitedHealthcare in California Qalsody (tofersen) requires prior authorization through UnitedHealthcare's OptumRx with strict documentation requirements. You'll need genetic confirmation of SOD1 mutation, neurologist involvement, baseline ALSFRS-R scores, and evidence of riluzole/edaravone trial or contraindication. Submit via the UnitedHealthcare provider
6 min read

Complete Guide to Getting Juxtapid (Lomitapide) Covered by Cigna in California: Forms, Appeals, and Step Therapy Overrides

Answer Box: Getting Juxtapid (Lomitapide) Covered by Cigna in California Eligibility: Patients with confirmed homozygous familial hypercholesterolemia (HoFH) who've failed maximum statins, ezetimibe, and PCSK9 inhibitors can get Juxtapid covered through Cigna's Express Scripts pharmacy benefit. Fastest path: Submit prior authorization with genetic testing, step therapy
6 min read

How to Get Kanuma (Sebelipase Alfa) Covered by Cigna in California: Complete Guide with Forms, Appeals, and Success Scripts

Answer Box: Getting Kanuma (Sebelipase Alfa) Covered by Cigna in California Cigna covers Kanuma (sebelipase alfa) for lysosomal acid lipase deficiency (LAL-D) in California, but requires prior authorization with strict medical necessity criteria. The fastest path to approval: (1) Confirm LAL-D diagnosis via enzyme activity testing or LIPA gene analysis,
6 min read