Topic

California

A collection of 403 issues

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,

Get Arikayce Covered by Aetna CVS Health in California: Prior Authorization, Appeals, and Coding Guide

Quick Answer: Getting Arikayce Covered by Aetna CVS Health in California Arikayce (amikacin liposome inhalation) requires prior authorization from Aetna CVS Health for refractory MAC lung disease. Submit your PA request through the Availity provider portal or call 1-866-814-5506. You'll need documentation of 6+ months of failed multidrug

How to Get Increlex (mecasermin) Covered by Blue Cross Blue Shield in California: Complete Appeals Guide with Templates

Answer Box: Getting Increlex (mecasermin) Covered by Blue Cross Blue Shield California Fastest path to approval: Your pediatric endocrinologist must submit prior authorization with documented severe primary IGF-1 deficiency (height ≤ -3.0 SDS, IGF-1 ≤ -3.0 SDS, normal/elevated GH levels). If denied, file an internal appeal within 180 days,

How to Get Hetlioz (tasimelteon) Covered by Aetna CVS Health in California: Complete Guide to Forms, Appeals, and PA Requirements

Answer Box: Getting Hetlioz Covered by Aetna CVS Health in California Hetlioz (tasimelteon) requires prior authorization from Aetna CVS Health and is dispensed through specialty pharmacy only. Key requirements include confirmed diagnosis (Non-24 or Smith-Magenis syndrome), specialist attestation, and documented failure of melatonin therapy. Submit PA requests via provider portal

How to Get Darzalex/Darzalex Faspro (Daratumumab) Covered by Cigna in California: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Darzalex Covered by Cigna in California Darzalex/Darzalex Faspro requires prior authorization from Cigna, but approval is achievable with proper documentation. In California, you have strong appeal rights through the DMHC's Independent Medical Review process if initially denied. Fastest path to approval: 1. Submit Cigna&

How to Get Rylaze (Asparaginase Erwinia Chrysanthemi) Covered by Blue Cross Blue Shield California: Complete Guide with Forms and Appeal Scripts

Quick Answer: Getting Rylaze Covered by Blue Cross Blue Shield California Eligibility: Rylaze requires prior authorization for ALL/LBL patients who've developed hypersensitivity to E. coli-derived asparaginase. Fastest path: Submit clinical documentation proving hypersensitivity reaction through Blue Shield's provider portal with supporting oncology notes. First step

How to Get Myalept (Metreleptin) Covered by Blue Cross Blue Shield in California: Complete Guide with Forms, Appeals, and REMS Requirements

Quick Answer: Myalept (metreleptin) requires prior authorization from Blue Cross Blue Shield California for generalized lipodystrophy patients. You'll need: 1) REMS program enrollment for prescriber and patient, 2) documented diagnosis with ICD-10 E88.1x, and 3) evidence of metabolic complications. Submit via the Blue Shield provider portal with

Get Pomalyst (Pomalidomide) Covered by Aetna CVS Health in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Pomalyst Covered by Aetna CVS Health in California Pomalyst (pomalidomide) requires prior authorization from Aetna CVS Health, REMS program enrollment, and specialty pharmacy dispensing. Success depends on documenting prior therapy failures (lenalidomide + proteasome inhibitor) and completing all REMS requirements. Fast track to approval: 1. Enroll in PS-Pomalidomide

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

Answer Box: Getting Qalsody (tofersen) Approved by Aetna (CVS Health) in California Aetna (CVS Health) requires prior authorization for Qalsody (tofersen) with documented SOD1 mutation, neurologist prescription, and baseline assessments. First step: Submit Aetna's Qalsody precertification form with genetic test results, ALSFRS-R scores, and clinical notes. Standard approval

How to Get Orladeyo (berotralstat) Covered by Humana in California: Appeals, Forms & Financial Aid

Answer Box: Getting Orladeyo (berotralstat) Covered by Humana in California Orladeyo (berotralstat) requires prior authorization from Humana and is typically placed on specialty tier (Tier 4). For California residents, the fastest path to approval involves: (1) Having your HAE specialist submit comprehensive PA documentation including C1-INH levels and prior therapy