Topic

California

A collection of 46 issues

Coding That Helps Get Idelvion (albutrepenonacog alfa) Approved by UnitedHealthcare in California: ICD-10, J-Code, and NDC Guide

Answer Box: Getting Idelvion Covered by UnitedHealthcare in California Idelvion (albutrepenonacog alfa) requires prior authorization from UnitedHealthcare with specific coding: Use ICD-10 code D67 (hereditary factor IX deficiency), HCPCS J7202 (1 IU per billing unit), and the correct NDC for your vial strength. Submit clinical documentation showing hemophilia B diagnosis,

How to Get Tagrisso (osimertinib) Covered by UnitedHealthcare in California: Prior Authorization, Appeals & Cost Assistance

Answer Box: Getting Tagrisso Covered by UnitedHealthcare in California Quick answer: Tagrisso requires prior authorization from UnitedHealthcare but has $0 copay for covered patients. To get approved: (1) Submit PA with EGFR mutation test results through your doctor, (2) If denied, file internal appeal within 180 days, (3) Request California

How to Get Hemlibra (Emicizumab) Covered by UnitedHealthcare in California: Complete Guide to Forms, Appeals, and Approval

Quick Answer: Getting Hemlibra Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Hemlibra (emicizumab-kxwh) in California. The fastest path: Your doctor submits a PA request through the UnitedHealthcare Provider Portal with clinical documentation showing hemophilia A diagnosis and inhibitor status. If denied, file an internal appeal within 180

How to Get Bylvay (odevixibat) Covered by UnitedHealthcare in California: Forms, Timelines & Appeal Scripts

Answer Box: Fastest Path to Bylvay Coverage Bylvay (odevixibat) is covered on UnitedHealthcare's California HMO formulary as Tier 3 with prior authorization required. To get approved: 1) Ensure your gastroenterologist or hepatologist submits PA documentation including genetic PFIC diagnosis (or confirmed Alagille syndrome), moderate-to-severe pruritus, failure of two

How to Get Ofev (nintedanib) Covered by Aetna CVS Health in California: Prior Authorization Guide and Appeals Process

Answer Box: Getting Ofev (nintedanib) Covered by Aetna CVS Health in California Ofev (nintedanib) is covered by Aetna CVS Health as a Tier 4 specialty drug with strict prior authorization requirements. You'll need HRCT showing ≥10% lung fibrosis, recent PFTs (FVC ≥45% predicted), and evidence of disease progression

Get Elevidys Covered by UnitedHealthcare in California: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Elevidys Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Elevidys (delandistrogene moxeparvovec-rokl) gene therapy for DMD. The fastest path to approval involves three key steps: (1) Submit a complete PA request through the UnitedHealthcare Provider Portal with genetic confirmation, anti-AAVrh74 antibody results ≤1:400, and

Myths vs. Facts: Getting Helixate (antihemophilic factor, rFVIII) Covered by Aetna (CVS Health) in California

Answer Box: Helixate Coverage Through Aetna (CVS Health) in California Helixate (recombinant factor VIII) requires prior authorization from Aetna (CVS Health) and may face coverage challenges due to product discontinuation in the US. Alternative rFVIII products like Kovaltry or Jivi are typically covered with proper documentation. In California, if denied,

Getting Imbruvica (ibrutinib) Covered by Aetna CVS Health in California: Complete Guide to Prior Authorization, Appeals, and Financial Support

Answer Box: Your Fastest Path to Coverage Imbruvica (ibrutinib) requires prior authorization from Aetna CVS Health in California. Step therapy is not required for CLL/SLL, but complete clinical documentation is essential. If denied, California's Independent Medical Review (IMR) process has high success rates for FDA-approved cancer drugs.

Denied for Adynovate by UnitedHealthcare in California? How to Appeal (Templates & Timelines)

Answer Box: Getting Adynovate Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Adynovate (bdanocog alfa pegol) with step therapy requirements. If denied, California residents can appeal through internal grievances, then request an Independent Medical Review (IMR) with high success rates for medically necessary treatments. First step today: Call

How to Get Xospata (Gilteritinib) Covered by Aetna CVS Health in California: Timeline, Appeals, and Approval Steps

Answer Box: Getting Xospata Covered by Aetna CVS Health in California Xospata (gilteritinib) requires prior authorization from Aetna CVS Health but is covered for relapsed/refractory AML with FLT3 mutations. Most approvals happen within 24 hours of complete submission. Key requirements: confirmed FLT3 mutation test, AML diagnosis, and prior therapy