Topic

California

A collection of 401 issues

Myths vs. Facts: Getting Uplizna (Inebilizumab) Covered by UnitedHealthcare in California

Quick Answer: UnitedHealthcare requires prior authorization for Uplizna (inebilizumab) in California with specific documentation: AQP4-positive NMOSD diagnosis, neurologist prescription, HBV screening, and often step therapy with eculizumab first. If denied, file internal appeal within 180 days, then California's Independent Medical Review (IMR) through DMHC. Start by gathering AQP4-IgG
5 min read

How to Get Amondys 45 (casimersen) Covered by Cigna in California: Complete Prior Authorization, Appeals, and Forms Guide

Answer Box: Getting Amondys 45 Covered by Cigna in California Cigna covers Amondys 45 (casimersen) for Duchenne muscular dystrophy patients under 14 years old with confirmed exon 45-amenable gene mutations, but requires prior authorization via Coverage Policy IP0137. Fastest path: Have your neuromuscular specialist submit genetic test results showing "
7 min read

Get Brensocatib (BRINSUPRI) Covered by UnitedHealthcare in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting BRINSUPRI Covered by UnitedHealthcare in California Brensocatib (BRINSUPRI) requires prior authorization through OptumRx for UnitedHealthcare plans in California. Coverage typically requires documented trial and failure of macrolide antibiotics, confirmed non-cystic fibrosis bronchiectasis diagnosis with ≥2 exacerbations per year, and age 12+. First step: Have your pulmonologist submit
6 min read

Renewing Approval for Jaypirca (Pirtobrutinib) with Blue Cross Blue Shield in California: What to Prepare & When

Answer Box: Renewing Your Jaypirca Coverage Jaypirca (pirtobrutinib) requires annual reauthorization with Blue Cross Blue Shield in California, typically 6-12 months after initial approval. Start the renewal process 30-45 days before your current authorization expires to avoid treatment gaps. Your oncologist must submit updated clinical documentation showing ongoing benefit, tolerability,
6 min read

Renewing Xywav (Ca/Mg/K/Na oxybates) Approval with Blue Cross Blue Shield in California: Annual Requirements, Timeline & Bridge Options

Answer Box: Xywav Renewal with Blue Cross Blue Shield California Blue Shield of California requires annual reauthorization for Xywav with documentation of continued clinical benefit, appropriate dosing, and ongoing safety monitoring. Submit renewal requests 30-60 days before expiration through AuthAccel or CoverMyMeds. Required documentation includes recent progress notes showing reduced
6 min read

How to Get Acthar Gel Approved by UnitedHealthcare in California: Prior Authorization Guide & Appeal Process

Answer Box: Getting Acthar Gel Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Acthar Gel (repository corticotropin injection) with strict medical necessity criteria limited to infantile spasms under age 2 and opsoclonus-myoclonus syndrome. Step therapy requiring documented failure of high-dose corticosteroids is mandatory for most conditions. If denied,
6 min read