Topic

California

A collection of 425 issues

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

Answer Box: Tysabri (natalizumab) requires prior authorization from Aetna CVS Health for all California plans. Success requires: (1) TOUCH program enrollment by both patient and neurologist, (2) documented MS diagnosis with MRI evidence, (3) JCV antibody testing results, and (4) step therapy documentation for Crohn's disease. Submit the

How to Get Advate (octocog alfa) Covered by Cigna in California: Complete PA Forms, Appeals & Contact Guide

Answer Box: Getting Advate (octocog alfa) Covered by Cigna in California Fast Track to Approval: Cigna requires prior authorization for Advate (octocog alfa) in California. Your hematologist must submit Form 61-211 with clinical documentation to 800-390-9745. Standard review takes 72 hours; expedited takes 24 hours for urgent cases. If denied,

How to Get Oxlumo (Lumasiran) Covered by Aetna CVS Health in California: Complete Guide with Forms and Appeals

Answer Box: Getting Oxlumo (Lumasiran) Covered by Aetna CVS Health in California Eligibility: Aetna CVS Health covers Oxlumo for primary hyperoxaluria type 1 (PH1) with confirmed AGXT gene mutation or liver enzyme deficiency. Fastest approval path: Submit the Aetna Oxlumo precertification form with genetic test results and specialist documentation. First

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

Answer Box: Getting Qinlock (ripretinib) Covered by Aetna CVS Health in California Qinlock (ripretinib) requires prior authorization through Aetna CVS Health for GIST patients in California. The fastest path to approval: 1) Have your oncologist submit a PA request via the Aetna provider portal with complete GIST diagnosis, prior TKI

How to Get Carbaglu (Carglumic Acid) Covered by Blue Cross Blue Shield in California: Prior Authorization, Appeals & Forms

Quick Answer: Getting Carbaglu Covered by Blue Cross Blue Shield in California Carbaglu (carglumic acid) is covered as a specialty drug by Blue Shield of California and Anthem Blue Cross, but requires prior authorization. The fastest path to approval: (1) Have your metabolic specialist submit a prior authorization with genetic

How to Get Krystexxa (Pegloticase) Covered by Humana in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Krystexxa Covered by Humana in California Krystexxa (pegloticase) requires prior authorization for all Humana Medicare Advantage plans in California. The fastest path to approval: 1) Ensure you have a rheumatologist prescriber, documented failure of allopurinol and febuxostat, normal G6PD test results, and current methotrexate therapy (unless contraindicated)

How Long Does It Take to Get Haegarda Approved by Blue Cross Blue Shield in California? Timeline & Milestones

Answer Box: Getting Haegarda Approved in California Getting Haegarda (C1-esterase inhibitor, SC) approved by Blue Cross Blue Shield California typically takes 5-15 business days for initial review, plus 1-3 days for pre-submission preparation. The fastest path requires complete HAE diagnosis documentation (C1-INH levels, C4 levels, attack history) submitted through Blue

How Long Does It Take to Get Taltz (Ixekizumab) Approved by Blue Cross Blue Shield in California? Complete Timeline Guide

Answer Box: Getting Taltz (Ixekizumab) Covered by Blue Cross Blue Shield in California Standard timeline: 15 business days for prior authorization approval after complete submission. Blue Cross Blue Shield California requires specialist consultation, documented diagnosis (moderate-to-severe plaque psoriasis, psoriatic arthritis, or spondyloarthritis), and proof of inadequate response to first-line therapies.

Getting Orkambi (Lumacaftor/Ivacaftor) Covered by Blue Cross Blue Shield in California: Complete Guide to Prior Authorization and Appeals

Answer Box: Quick Path to Orkambi Coverage in California Orkambi (lumacaftor/ivacaftor) requires prior authorization from Blue Cross Blue Shield of California for patients with cystic fibrosis who are F508del homozygous. Success requires three key elements: genetic testing documentation, specialist prescription, and proper ICD-10 coding (E84.0-E84.9). If denied,

How to Get Humira (adalimumab) Covered by Cigna in California: 2025 Biosimilar Changes and Appeal Guide

Quick Answer: Getting Humira (adalimumab) Covered by Cigna in California Starting in 2025, Cigna's Express Scripts has removed brand-name Humira from most commercial formularies, favoring biosimilar alternatives at $0 copay through Accredo. To get Humira covered, you'll need a formulary exception with clinical documentation showing biosimilar