Topic

California

A collection of 425 issues

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

Answer Box: Getting Pomalyst Covered by Blue Cross Blue Shield in California Blue Cross Blue Shield California requires prior authorization for Pomalyst (pomalidomide). To get approved: (1) Ensure your oncologist documents progression after ≥2 prior therapies including lenalidomide and a proteasome inhibitor, (2) Complete REMS program enrollment for prescriber, patient,

Blue Cross Blue Shield California Coverage for Acthar Gel: Medical Necessity Criteria, Prior Authorization, and Appeals Guide

Answer Box: Getting Acthar Gel Covered in California Blue Cross Blue Shield California requires prior authorization for Acthar Gel with documented failure of corticosteroids first. The fastest path: Have your doctor submit a PA request through the provider portal with complete clinical notes showing corticosteroid trial failure or contraindications. If

How to Get Aldurazyme (laronidase) Covered by Aetna CVS Health in California: Complete Prior Authorization & Appeal Guide

Quick Answer: Getting Aldurazyme Covered by Aetna CVS Health in California Aldurazyme (laronidase) requires prior authorization from Aetna CVS Health for all plan types in California. Coverage is approved for confirmed MPS I (Hurler, Hurler-Scheie, or moderate-to-severe Scheie forms) with enzyme/genetic testing documentation. The medication is placed on specialty

Getting Garadacimab (ANDEMBRY) Covered by Cigna in California: Complete 2025 Prior Authorization Guide

Quick Answer: Getting Garadacimab Covered by Cigna in California Yes, Cigna covers garadacimab (ANDEMBRY®) for hereditary angioedema prophylaxis in California, but prior authorization is required. The fastest path: gather HAE diagnosis labs (C4, C1-INH levels), document failed prior therapies, complete REMS training, and submit through Express Scripts' portal. If

How to Get Soliris (Eculizumab) Covered by Humana in California: Complete Prior Authorization Guide

Answer Box: Getting Soliris Covered by Humana in California Humana requires prior authorization for Soliris (eculizumab) in California, with strict clinical criteria based on FDA-approved indications. Your fastest path to approval: 1) Confirm your diagnosis meets FDA criteria (PNH, aHUS, gMG, or NMOSD) with supporting lab work, 2) Submit a

How to Get Breyanzi (Lisocabtagene Maraleucel) Covered by Cigna in California: Complete Requirements Guide

Quick Answer: Getting Breyanzi Covered by Cigna in California To get Breyanzi (lisocabtagene maraleucel) covered by Cigna in California, you'll need prior authorization through their specialty pharmacy partner Express Scripts/Accredo. The fastest path: (1) Submit complete PA documentation including FDA-approved indication criteria, prior therapy failures, and REMS

How to Get Kineret (anakinra) Covered by Blue Cross Blue Shield in California: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Kineret Covered in California Kineret (anakinra) requires prior authorization from Blue Cross Blue Shield California and is placed on the specialty tier. For rheumatoid arthritis, you must first try two preferred agents (like Humira or Enbrel) and methotrexate unless contraindicated. If denied, California offers a strong Independent

Work With Your Doctor to Get Photrexa Covered by Cigna in California: Complete Appeals Guide

Answer Box: Getting Photrexa Covered by Cigna in California Fastest path to approval: Work with your ophthalmologist to submit a prior authorization (PA) request with documented keratoconus progression evidence—specifically Kmax increase ≥1.0 diopter and serial corneal topography. If denied, file an internal appeal within 180 days, then request

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

Answer Box: Getting Bylvay Covered by Blue Cross Blue Shield in California Yes, Blue Cross Blue Shield covers Bylvay (odevixibat) in California for FDA-approved uses—pruritus in PFIC and Alagille syndrome—but requires prior authorization with specialist documentation. The fastest path to approval: 1) Have a hepatologist or gastroenterologist submit

How to Get Humate-P Covered by Cigna in California: 2024 Forms, Appeal Scripts & Timeline

Answer Box: Getting Humate-P Covered by Cigna in California Humate-P (antihemophilic factor/vWF complex) requires prior authorization from Cigna, managed through Accredo Specialty Pharmacy. The fastest path to approval: (1) Have your hematologist submit the Cigna Hemophilia Factor VIII CCRD Prior Authorization Form with VWF:RCo and FVIII:C lab