Topic

California

A collection of 426 issues

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

The Requirements Checklist to Get Bavencio (avelumab) Covered by Blue Cross Blue Shield in California

Answer Box: Getting Bavencio Covered by Blue Cross Blue Shield in California Bavencio (avelumab) requires prior authorization from Blue Cross Blue Shield in California for metastatic Merkel cell carcinoma and urothelial carcinoma. Your fastest path to approval: 1) Gather complete diagnosis records and prior treatment history, 2) Submit the PA

How to Get Tremfya (Guselkumab) Covered by Aetna CVS Health in California: Prior Authorization, Appeals & Cost Savings

Answer Box: Fast Track to Tremfya Coverage Getting Tremfya (guselkumab) covered by Aetna CVS Health in California requires prior authorization through a dermatologist or rheumatologist. Submit documentation showing moderate-to-severe disease (≥10% body surface area or crucial areas affected) plus failure/intolerance of conventional treatments. First step: Have your specialist complete

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

Quick Answer: Getting Rapivab Covered by Blue Cross Blue Shield in California Blue Shield of California requires prior authorization for Rapivab (peramivir) with strict criteria: symptoms ≤48 hours, documented intolerance to oral antivirals (Tamiflu, Relenza, Xofluza), and positive flu test. Submit PA via fax with clinical documentation. If denied, file

Blue Cross Blue Shield California Prior Authorization for Thiola / Thiola EC (Tiopronin): Complete Coverage Guide with Appeal Scripts

Answer Box: Getting Thiola / Thiola EC Covered in California Blue Cross Blue Shield of California requires prior authorization for Thiola / Thiola EC (tiopronin), with approval based on documented cystinuria diagnosis, failed conservative therapy, and ongoing medical necessity. Your fastest path to approval: (1) Gather 24-hour urine cystine results >500

How to Get Firazyr (Icatibant) Covered by UnitedHealthcare in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Firazyr Covered by UnitedHealthcare in California Firazyr (icatibant) requires strict prior authorization from UnitedHealthcare for hereditary angioedema (HAE) treatment. You'll need confirmed HAE diagnosis (ICD-10: D84.1), specialist prescription, documented failure of preferred alternatives (like Berinert), and self-administration training proof. Generic icatibant is typically covered

Myths vs. Facts: Getting Skyrizi (Risankizumab) Covered by Humana in California

Answer Box: Skyrizi Coverage Through Humana in California Getting Skyrizi (risankizumab) covered by Humana requires prior authorization with step therapy documentation. Most patients must show failure or intolerance to TNF inhibitors first. The fastest path: have your doctor submit complete PA documentation including TB screening, prior therapy details, and medical

How to Get Alecensa (alectinib) Covered by Cigna in California: Forms, Appeals, and Contact Numbers

Quick Answer: Getting Alecensa (alectinib) Covered by Cigna in California Your doctor must submit a prior authorization request with ALK-positive test results and complete clinical documentation. In California, Cigna has 72 hours to respond to non-urgent requests (24 hours for urgent cases). If denied, you can appeal internally through Cigna,

How Long Does It Take to Get Nucala (Mepolizumab) Approved by Cigna in California? Complete Timeline & Appeals Guide

Quick Answer: Nucala (Mepolizumab) Approval Timeline with Cigna in California Standard timeline: 2-15 business days from complete submission. Cigna/Express Scripts typically responds within 2 business days for routine requests, up to 15 business days maximum under California law. Expedited reviews: 72 hours for urgent cases. Fastest path to approval:

Do You Qualify for Enbrel (Etanercept) Coverage by Cigna in California? Complete Decision Tree & Appeals Guide

Answer Box: Your Fastest Path to Enbrel Coverage Most Cigna California members can get Enbrel (etanercept) covered if they meet three key criteria: confirmed moderate-to-severe rheumatoid arthritis or psoriasis, failure of at least one conventional therapy, and completed TB/hepatitis B screening. First step today: Have your rheumatologist or dermatologist