Topic

California

A collection of 492 issues

How Long Does It Take to Get Hetlioz LQ (tasimelteon) Approved by Aetna CVS Health in California? Complete Timeline Guide

Answer Box: Quick Timeline Overview Aetna CVS Health prior authorization for Hetlioz LQ (tasimelteon oral suspension) in California takes 15-30 business days for standard review, with expedited approval available within 72 hours for urgent cases. Submit via electronic prior authorization (ePA) through CVS Caremark portal for fastest processing—over 95%
5 min read

Renewing Pyrukynd (Mitapivat) Approval with Humana in California: Timeline, Documents & Appeal Process

Answer Box: Renewing Pyrukynd (Mitapivat) with Humana in California Pyrukynd (mitapivat) requires annual reauthorization with Humana Medicare Advantage plans. Start renewal 60-90 days before your current authorization expires. Submit updated clinical documentation showing continued medical necessity: hemoglobin levels, transfusion records, and treatment response data from the past 24 weeks. If
6 min read

How to Get Cimzia (Certolizumab Pegol) Covered by Aetna CVS Health in California: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Cimzia Approved by Aetna CVS Health in California Cimzia (certolizumab pegol) requires prior authorization from Aetna CVS Health and faces step therapy requirements favoring preferred biologics. Success requires documenting failed trials of preferred TNF inhibitors (like Humira or infliximab biosimilars), negative TB/hepatitis B screening, and meeting
6 min read

How to Get Jynarque (Tolvaptan) Covered by Blue Cross Blue Shield in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Jynarque Covered in California Blue Shield of California requires prior authorization for Jynarque (tolvaptan) for ADPKD patients 18+ prescribed by nephrologists. Submit via AuthAccel portal or fax (800) 633-4581 with baseline eGFR, imaging showing rapid progression, and REMS enrollment. Standard review takes 14 business days. If denied,
5 min read

The Complete Guide to Getting Zolgensma (onasemnogene abeparvovec) Covered by Humana in California: Prior Authorization, Appeals, and Success Strategies

Answer Box: Getting Zolgensma Covered by Humana in California Humana requires prior authorization for Zolgensma (onasemnogene abeparvovec) with genetic confirmation of SMN1 bi-allelic mutation, age under 24 months, negative AAV9 antibodies, and prescription from a certified gene therapy center. Submit PA via Humana's provider portal with complete genetic
5 min read