Topic

California

A collection of 411 issues

How to Get Besponsa (Inotuzumab Ozogamicin) Covered by Cigna in California: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Besponsa Covered by Cigna in California Besponsa (inotuzumab ozogamicin) requires prior authorization from Cigna in California. Your fastest path to approval: 1) Have your oncologist submit a PA request through Cigna's provider portal with complete CD22+ B-cell ALL documentation, 2) If denied, file an internal

Get Retevmo (Selpercatinib) Approved by Aetna CVS Health in California: Complete Guide to Prior Authorization, Appeals & Timeline

Answer Box: Your Fastest Path to Retevmo Coverage Retevmo (selpercatinib) requires prior authorization from Aetna CVS Health in California. To get approved fastest: (1) Ensure RET alteration testing via FDA-approved methods like FoundationOne CDx is documented, (2) Have your oncologist submit the PA with complete clinical records through CVS Specialty&

How to Get Epidiolex (Cannabidiol) Covered by Blue Shield of California: Complete Timeline, Forms & Appeal Strategies

Answer Box: Getting Epidiolex Covered by Blue Shield of California Blue Shield of California requires prior authorization for Epidiolex (cannabidiol) for seizures associated with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex. Standard approvals take 24-72 hours with complete documentation. To get started today: (1) Confirm your diagnosis matches FDA-approved

Myths vs. Facts: Getting Kalydeco (ivacaftor) Covered by Cigna in California

Quick Answer: To get Kalydeco (ivacaftor) covered by Cigna in California, you need prior authorization with CFTR genetic testing documentation and a CF specialist's prescription. If denied, file an internal appeal within 180 days, then request California's Independent Medical Review (IMR) through DMHC. Success rates for

How to Get Dojolvi (triheptanoin) Covered by Cigna in California: Complete PA Requirements and Appeals Guide

Quick Answer: Getting Dojolvi (triheptanoin) Covered by Cigna in California Cigna requires prior authorization for Dojolvi (triheptanoin) with molecular confirmation of LC-FAOD diagnosis, specialist prescribing, and documented MCT oil discontinuation. Submit through Express Scripts/Accredo with genetic testing results, treatment history, and medical necessity letter. If denied, file internal appeal

How to Get Dojolvi (Triheptanoin) Covered by Aetna CVS Health in California: Complete Timeline, Appeals Guide, and Required Documentation

Answer Box: Getting Dojolvi (Triheptanoin) Covered by Aetna CVS Health in California Fastest path to approval: Submit complete prior authorization through Aetna's provider portal with genetic confirmation of long-chain fatty acid oxidation disorder (LC-FAOD), specialist consultation notes, and medical necessity letter. Standard review takes 30 days; expedited review

How to Get Uplizna (Inebilizumab) Covered by Aetna CVS Health in California: Prior Authorization, Appeals, and State Protections Guide

Answer Box: Getting Uplizna (Inebilizumab) Covered by Aetna CVS Health in California Fast track to approval: Aetna requires prior authorization for Uplizna (inebilizumab) with proof of AQP4-positive NMOSD diagnosis and specialist involvement. California law provides strong appeal rights—including Independent Medical Review (IMR) with 68% success rates for specialty drugs

Arikayce Coverage with UnitedHealthcare in California: Complete Guide to Prior Authorization, Appeals, and Approval Timeline

Answer Box: Getting Arikayce Covered by UnitedHealthcare in California Arikayce requires prior authorization from UnitedHealthcare through OptumRx. To qualify, you must have refractory MAC lung disease with positive cultures after at least 6 months of combination therapy (macrolide + ethambutol + rifamycin). Your fastest path: Have your pulmonologist or infectious disease specialist

The Requirements Checklist to Get Natpara (Parathyroid Hormone) Covered by Aetna (CVS Health) in California

Quick Answer: Getting Natpara (parathyroid hormone) covered by Aetna (CVS Health) in California requires prior authorization with strict clinical documentation. You'll need confirmed hypoparathyroidism diagnosis, failed calcium/vitamin D therapy records, and endocrinologist support. Important: Takeda discontinued Natpara manufacturing globally in late 2024, with U.S. supply ending

How to Get Jakafi (Ruxolitinib) Covered by Aetna CVS Health in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Jakafi Covered by Aetna CVS Health in California Aetna CVS Health requires prior authorization for Jakafi (ruxolitinib) in California. Submit your request at least 2 weeks in advance via the Availity portal with complete documentation: confirmed diagnosis, hydroxyurea failure evidence (if applicable), baseline labs, and prescriber attestation