Topic

California

A collection of 403 issues

How to Get Nucala (Mepolizumab) Covered by Humana in California: Complete Timeline, Forms & Appeals Guide

Answer Box: Getting Nucala Covered by Humana in California Humana requires prior authorization for Nucala (mepolizumab) with a 7-day standard decision timeline starting January 2025. Key requirements: blood eosinophil count ≥150 cells/μL, severe asthma despite 3+ months of optimized inhaled therapy, and age ≥6 years. Submit via CoverMyMeds or

How to Get Soliris (Eculizumab) Covered by Blue Cross Blue Shield in California: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Soliris Covered by Blue Cross Blue Shield in California Blue Cross Blue Shield requires prior authorization for Soliris (eculizumab) for all covered conditions including PNH, aHUS, myasthenia gravis, and NMOSD. First step: Gather diagnosis documentation, lab results (LDH levels for PNH, ADAMTS 13 for aHUS), and proof

The Requirements Checklist to Get Xenpozyme (olipudase alfa-rpcp) Covered by Humana in California

Answer Box: Getting Xenpozyme Covered by Humana in California Fastest path to approval: Humana requires prior authorization for Xenpozyme (olipudase alfa-rpcp) with strict diagnostic and documentation standards. You'll need confirmed ASMD diagnosis (genetic testing + enzyme deficiency), specialist oversight, and complete medical necessity documentation. Submit via Humana's

How to Get Onivyde (Irinotecan Liposome) Covered by Aetna CVS Health in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Onivyde Approved by Aetna CVS Health in California Onivyde (irinotecan liposome) requires prior authorization from Aetna CVS Health in California for pancreatic cancer treatment. The fastest path to approval involves submitting a complete PA request with documented medical necessity, prior therapy failures, and performance status. If denied,

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

Answer Box: Getting Kalydeco Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Kalydeco (ivacaftor) as a Tier 5 specialty medication. The fastest path to approval involves three steps: 1) Submit genetic testing confirming an FDA-approved ivacaftor-responsive CFTR mutation, 2) Provide clinical documentation from a CF specialist confirming cystic

Getting Elzonris (Tagraxofusp-erzs) Covered by Humana in California: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Your Fastest Path to Coverage Elzonris (tagraxofusp-erzs) requires prior authorization from Humana and is classified as a specialty medication with high cost-sharing. To get approved: (1) Gather pathology confirming CD123-positive BPDCN diagnosis and serum albumin ≥3.2 g/dL, (2) Have your hematologist/oncologist submit PA via Humana

Do You Qualify for Elelyso (taliglucerase alfa) Coverage by Aetna (CVS Health) in California? Decision Tree & Next Steps

Answer Box: Quick Eligibility Check You likely qualify for Elelyso (taliglucerase alfa) coverage by Aetna (CVS Health) in California if: You have confirmed Type 1 Gaucher disease (enzyme/genetic testing), are prescribed by a specialist, and meet FDA dosing guidelines (60 units/kg every other week). First step today: Contact

How to Get Luxturna (Voretigene Neparvovec-rzyl) Covered by UnitedHealthcare in California: Complete Guide with Forms and Appeal Process

Answer Box: Getting Luxturna Covered by UnitedHealthcare in California Eligibility: Patients over 12 months with confirmed biallelic RPE65 mutations and sufficient retinal cells (>100 μm posterior pole thickness on OCT). Fastest path: Submit prior authorization through OptumRx with genetic testing results, OCT imaging, and qualified retinal surgeon documentation. First

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

Answer Box: Getting Kineret Covered by Humana in California Kineret (anakinra) requires prior authorization from Humana and must be dispensed through CenterWell Specialty Pharmacy. California patients have strong appeal rights through Independent Medical Review (IMR) if denied. Start today: Have your rheumatologist submit a prior authorization request with documented failure

How to Get Myozyme (Alglucosidase Alfa) Covered by Cigna in California: Complete Renewal Guide with Appeals Process

Answer Box: Getting Myozyme Covered by Cigna in California Myozyme (alglucosidase alfa) requires annual prior authorization renewal through Cigna, typically managed via Express Scripts/Accredo specialty pharmacy. Submit renewal requests 5 business days before expiration with updated clinical documentation showing continued benefit. If denied, California residents can file an Independent