Topic

California

A collection of 404 issues

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

Work With Your Doctor to Get Filspari (sparsentan) Approved by Cigna in California: Complete Coverage Guide

Answer Box: Getting Filspari (sparsentan) Covered by Cigna in California Cigna requires prior authorization for Filspari (sparsentan) in IgA nephropathy, mandating biopsy-confirmed diagnosis, nephrologist prescription, and quarterly liver function tests through their REMS program. Your fastest path to approval: Schedule a visit with your nephrologist to document proteinuria ≥0.8

How to Get Dupixent (dupilumab) Covered by Aetna (CVS Health) in California: Complete Prior Authorization Guide

Answer Box: Get Dupixent Covered by Aetna in California Fastest Path to Approval: Aetna requires prior authorization for all Dupixent uses. Your dermatologist or allergist must submit documentation showing failed trials of topical treatments (corticosteroids and calcineurin inhibitors) within 180 days, plus proof of moderate-to-severe disease. Standard approval takes 30-45

Get Jakafi (Ruxolitinib) Covered by Blue Cross Blue Shield in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Jakafi Coverage Path Blue Cross Blue Shield of California requires prior authorization for Jakafi (ruxolitinib). Approval depends on confirmed diagnosis (myelofibrosis or polycythemia vera), adequate platelet counts (≥50,000/mcL), and documented hydroxyurea failure for PV patients. Submit via Blue Shield's AuthAccel portal with complete labs,

The Requirements Checklist to Get Synagis (Palivizumab) Covered by Blue Cross Blue Shield in California: Forms, Timelines, and Appeal Strategies

Answer Box: Getting Synagis Coverage in California Synagis (palivizumab) requires prior authorization from Blue Cross Blue Shield plans in California. The fastest path to approval: (1) Submit PA request through Blue Shield's Provider Connection portal with complete clinical documentation showing high-risk RSV criteria, (2) Include cardiology/pulmonology notes

How to Get Naglazyme (galsulfase) Covered by Aetna CVS Health in California: Prior Authorization, Appeals, and Cost Strategies

Answer Box: Getting Naglazyme Covered by Aetna CVS Health in California Naglazyme (galsulfase) requires prior authorization from Aetna CVS Health and must be dispensed through CVS Specialty Pharmacy. Standard approval takes 30-45 days, but expedited reviews are available for urgent cases (72 hours). Essential requirements: confirmed MPS VI diagnosis via

How to Get Vyondys 53 (Golodirsen) Covered by Cigna in California: Timeline, Forms & Appeals Guide

Quick Answer: Getting Vyondys 53 Covered by Cigna in California Fastest path to approval: Your neurologist submits a prior authorization (PA) through Express Scripts with genetic testing proof of exon 53-skippable DMD mutation. Standard review takes 2 business days; urgent cases get 72-hour decisions. If denied, file internal appeal within

How to Get Myalept (Metreleptin) Covered by Cigna in California: Appeals Guide & Templates

Answer Box: Getting Myalept (Metreleptin) Covered by Cigna in California Fastest path to approval: Submit a complete prior authorization with confirmed generalized lipodystrophy diagnosis, REMS certification, and metabolic documentation. If denied, file an internal appeal within 65-90 days with medical necessity letter and supporting evidence. California residents can then request

How to Get HyperHEP Covered by Blue Cross Blue Shield in California: Appeals, Forms & Timelines

Answer Box: Blue Cross Blue Shield California requires prior authorization for HyperHEP (hepatitis B immune globulin). To get coverage: 1) Submit PA with exposure documentation and CDC guideline citations within 7 days of exposure, 2) If denied, file internal appeal with medical necessity letter within 180 days, 3) Request Independent

How to Get Trikafta (elexacaftor/tezacaftor/ivacaftor) Covered by Humana in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Trikafta Covered by Humana in California Trikafta requires prior authorization from Humana in California. To get approved: (1) Submit Humana's "Request for Medicare Prescription Drug Coverage Determination" form with CFTR genetic testing results confirming F508del or other responsive mutation, (2) Include CF diagnosis