Topic

California

A collection of 492 issues

How to Get Fabrazyme (Agalsidase Beta) Covered by Humana in California: Prior Authorization Forms, Appeals Timeline, and Success Scripts

Answer Box: Getting Fabrazyme Covered by Humana in California Fabrazyme (agalsidase beta) requires prior authorization from Humana in California. Success depends on three key steps: (1) Submit biochemical confirmation of Fabry disease (alpha-Gal A enzyme deficiency <5% and/or pathogenic GLA mutation), (2) Use CenterWell Specialty Pharmacy or approved

How to Get Enbrel (etanercept) Covered by Aetna (CVS Health) in California: Complete Forms, Appeals & Contact Guide

Answer Box: Getting Enbrel (etanercept) Covered by Aetna (CVS Health) in California Enbrel requires prior authorization from Aetna (CVS Health) with step therapy requirements for most conditions. Your fastest path to approval: 1) Have your doctor submit the California-specific PA form via CVS Caremark portal or fax to 1-877-309-8077, 2)

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

Quick Answer: Translarna (ataluren) currently lacks FDA approval and is not covered by UnitedHealthcare formularies as of 2026. However, you can pursue coverage through prior authorization exceptions with genetic testing documentation, specialist letters, and appeals. California residents have strong appeal rights through DMHC Independent Medical Review (IMR) with ~55% overturn

Work With Your Doctor to Get Fintepla (Fenfluramine) Approved by Blue Cross Blue Shield in California: Complete Provider Collaboration Guide

Answer Box: Getting Fintepla Approved in California Fintepla (fenfluramine) requires prior authorization from Blue Cross Blue Shield California, including REMS enrollment documentation and echocardiogram results to confirm eligibility for Dravet or Lennox-Gastaut syndrome. Your doctor must first enroll as a prescriber and enroll you as a patient at FinteplaREMS.com,

Resources to Get Cabometyx (cabozantinib) Approved with Humana in California: Forms, Portals & Appeal Guide

Answer Box: Getting Cabometyx (cabozantinib) Covered by Humana in California Cabometyx (cabozantinib) requires prior authorization for Humana Medicare Advantage plans in California. Submit your PA request via Humana's provider portal or fax form to 877-486-2621 within 72 hours for standard decisions. If denied, you have 65 days to

How to Get Xembify (Immune Globulin SC) Covered by Humana in California: Appeals Guide & Templates

Quick Answer: Getting Xembify Covered by Humana in California Xembify requires prior authorization from Humana, even though it's a preferred product under their Medicare Advantage plans. The fastest path to approval: gather your primary immunodeficiency diagnosis (IgG <300 mg/dL), document any prior IVIG trials and failures,

Myths vs. Facts: Getting Xywav (Ca/Mg/K/Na oxybates) Covered by Humana in California

Answer Box: Getting Xywav Covered by Humana in California Xywav requires prior authorization from Humana due to its high cost and REMS requirements. The fastest path: ensure your prescriber is REMS-certified, submit complete medical necessity documentation including diagnosis codes and prior treatment failures, and use Humana's provider portal

How to Get Prolastin-C (Alpha1-Proteinase Inhibitor) Covered by Cigna in California: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Prolastin-C Covered by Cigna in California Cigna requires prior authorization for Prolastin-C with specific clinical criteria: age ≥18, serum AAT <11 μM (80 mg/dL), confirmed emphysema on imaging, FEV1 30-65% predicted, and no tobacco use. Submit PA via CoverMyMeds with complete documentation. If denied, file

How to Get Orladeyo (Berotralstat) Covered by Cigna in California: Appeals Guide and Formulary Alternatives

Answer Box: Getting Orladeyo (Berotralstat) Covered by Cigna in California Cigna requires prior authorization (PA) for Orladeyo (berotralstat) for hereditary angioedema (HAE) prophylaxis. Submit through your doctor with confirmed HAE diagnosis (low C4 and C1-INH levels), age ≥12 years, and documented failure/intolerance of formulary alternatives like Takhzyro or Haegarda.

How to Get Zolgensma (onasemnogene abeparvovec-xioi) Covered by Blue Cross Blue Shield in California: Prior Authorization Guide, Appeals Process, and Success Strategies

Answer Box: Fast Track to Zolgensma Coverage Blue Shield of California requires prior authorization for Zolgensma with specific clinical criteria: confirmed SMA diagnosis via genetic testing, age under 2 years, ≤3 SMN2 gene copies, and no advanced disease. Submit through AuthAccel portal with genetic documentation. If denied, file internal appeal