Topic

California

A collection of 404 issues

How to Get Daybue (Trofinetide) Covered by Cigna in California: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Daybue (Trofinetide) Covered by Cigna in California Daybue (trofinetide) requires prior authorization from Cigna and is dispensed only through specialty pharmacies like Accredo. The fastest path to approval involves three steps: (1) Your neurologist submits a complete PA request with genetic testing showing MECP2 mutation and clinical

Get Ruconest (C1 Esterase Inhibitor) Covered by UnitedHealthcare in California: Complete 2025 Guide

Answer Box: Getting Ruconest Covered by UnitedHealthcare in California Yes, UnitedHealthcare covers Ruconest for hereditary angioedema (HAE), but requires prior authorization. The fastest path: have your HAE specialist submit a complete PA request with confirmed C1-INH deficiency labs, attack documentation, and proof you're not using it for prophylaxis.

How to Get Tavneos (Avacopan) Covered by Cigna in California: Prior Authorization, Appeals, and Alternative Options

Answer Box: Getting Tavneos Covered by Cigna in California Fastest path to approval: Cigna requires prior authorization for Tavneos (avacopan) with strict criteria—it must be prescribed by a rheumatologist, nephrologist, or pulmonologist for severe active ANCA-associated vasculitis (GPA/MPA) as an adjunct to standard immunosuppressive therapy (rituximab or cyclophosphamide)

How to Get Keytruda (Pembrolizumab) Covered by Aetna in California: Complete Guide with Forms and Appeal Scripts

Answer Box: To get Keytruda (pembrolizumab) covered by Aetna in California: (1) Submit prior authorization with PD-L1 test results and complete clinical documentation via Aetna's provider portal or fax 1-888-267-3277, (2) If denied, request peer-to-peer review within 14 days, then file internal appeal, (3) Use California's

How to Get Myozyme (Alglucosidase Alfa) Covered by Aetna CVS Health in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Myozyme Covered by Aetna CVS Health in California Myozyme (alglucosidase alfa) requires prior authorization from Aetna CVS Health, but approval is achievable with proper documentation. You'll need confirmed Pompe disease diagnosis (GAA enzyme deficiency + genetic testing) and specialist oversight. California residents have strong appeal rights

How to Get Acthar Gel Covered by Cigna in California: Complete Prior Authorization and Appeal Guide

Answer Box: Get Acthar Gel Covered by Cigna in California Cigna requires prior authorization for Acthar Gel (repository corticotropin injection) with mandatory step therapy through systemic corticosteroids and Cortrophin for most conditions except infantile spasms and acute MS exacerbations. California residents have strong appeal rights through the state's

How to Get Uptravi (selexipag) Covered by Aetna (CVS Health) in California: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Uptravi (selexipag) Covered by Aetna (CVS Health) in California Uptravi (selexipag) requires prior authorization from Aetna (CVS Health) with strict clinical criteria. You'll need a pulmonologist or cardiologist to prescribe it, documented WHO Group I PAH diagnosis, and often proof of trying other PAH medications

Work With Your Doctor to Get Rapivab (Peramivir) Approved by Aetna CVS Health in California: Complete Provider Collaboration Guide

Answer Box: Getting Rapivab Covered by Aetna CVS Health in California Rapivab (peramivir) requires prior authorization from Aetna CVS Health in California. The fastest path to approval: work closely with your doctor to submit comprehensive clinical documentation showing you meet FDA criteria (symptom onset ≤48 hours) and cannot take oral/

How to Get Lutathera (Lutetium Lu-177 Dotatate) Covered by UnitedHealthcare in California: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Lutathera Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Lutathera (lutetium Lu-177 dotatate) with step therapy documentation showing progression on somatostatin analogs. The fastest path to approval involves: 1. Submit PA request through the UnitedHealthcare Provider Portal with SSTR-positive imaging (Ga-68 DOTATATE PET/CT), pathology

Oxbryta (Voxelotor) Coverage by Aetna CVS Health in California: 2024 FDA Withdrawal and Your Treatment Options

Answer Box: Oxbryta (Voxelotor) Status and Next Steps Oxbryta (voxelotor) was voluntarily withdrawn from all U.S. markets in September 2024 due to safety concerns. Aetna CVS Health and all insurers no longer authorize this medication. If you were taking Oxbryta, contact your hematologist immediately to discuss alternatives like hydroxyurea,