Topic

California

A collection of 238 issues

Myths vs. Facts: Getting Kalydeco (ivacaftor) Covered by Cigna in California

Quick Answer: To get Kalydeco (ivacaftor) covered by Cigna in California, you need prior authorization with CFTR genetic testing documentation and a CF specialist's prescription. If denied, file an internal appeal within 180 days, then request California's Independent Medical Review (IMR) through DMHC. Success rates for

How to Get Dojolvi (triheptanoin) Covered by Cigna in California: Complete PA Requirements and Appeals Guide

Quick Answer: Getting Dojolvi (triheptanoin) Covered by Cigna in California Cigna requires prior authorization for Dojolvi (triheptanoin) with molecular confirmation of LC-FAOD diagnosis, specialist prescribing, and documented MCT oil discontinuation. Submit through Express Scripts/Accredo with genetic testing results, treatment history, and medical necessity letter. If denied, file internal appeal

How to Get Dojolvi (Triheptanoin) Covered by Aetna CVS Health in California: Complete Timeline, Appeals Guide, and Required Documentation

Answer Box: Getting Dojolvi (Triheptanoin) Covered by Aetna CVS Health in California Fastest path to approval: Submit complete prior authorization through Aetna's provider portal with genetic confirmation of long-chain fatty acid oxidation disorder (LC-FAOD), specialist consultation notes, and medical necessity letter. Standard review takes 30 days; expedited review

How to Get Uplizna (Inebilizumab) Covered by Aetna CVS Health in California: Prior Authorization, Appeals, and State Protections Guide

Answer Box: Getting Uplizna (Inebilizumab) Covered by Aetna CVS Health in California Fast track to approval: Aetna requires prior authorization for Uplizna (inebilizumab) with proof of AQP4-positive NMOSD diagnosis and specialist involvement. California law provides strong appeal rights—including Independent Medical Review (IMR) with 68% success rates for specialty drugs

Arikayce Coverage with UnitedHealthcare in California: Complete Guide to Prior Authorization, Appeals, and Approval Timeline

Answer Box: Getting Arikayce Covered by UnitedHealthcare in California Arikayce requires prior authorization from UnitedHealthcare through OptumRx. To qualify, you must have refractory MAC lung disease with positive cultures after at least 6 months of combination therapy (macrolide + ethambutol + rifamycin). Your fastest path: Have your pulmonologist or infectious disease specialist

The Requirements Checklist to Get Natpara (Parathyroid Hormone) Covered by Aetna (CVS Health) in California

Quick Answer: Getting Natpara (parathyroid hormone) covered by Aetna (CVS Health) in California requires prior authorization with strict clinical documentation. You'll need confirmed hypoparathyroidism diagnosis, failed calcium/vitamin D therapy records, and endocrinologist support. Important: Takeda discontinued Natpara manufacturing globally in late 2024, with U.S. supply ending

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

Quick Answer: Getting Jakafi Covered by Aetna CVS Health in California Aetna CVS Health requires prior authorization for Jakafi (ruxolitinib) in California. Submit your request at least 2 weeks in advance via the Availity portal with complete documentation: confirmed diagnosis, hydroxyurea failure evidence (if applicable), baseline labs, and prescriber attestation

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

Answer Box: Getting Firazyr Covered by Blue Cross Blue Shield in California Yes, Blue Cross Blue Shield California covers Firazyr (icatibant) for hereditary angioedema (HAE), but prior authorization is required. The fastest path to approval: (1) Confirm your HAE diagnosis with lab results showing low C4 and abnormal C1-INH levels,

Renewing Signifor LAR (Pasireotide) Coverage with Humana in California: Timeline, Documentation, and Appeals Guide

Answer Box: Renewing Your Signifor LAR Coverage Renewal triggers: Submit 30-45 days before current authorization expires. Key evidence: Updated UFC/IGF-1 labs showing response, recent clinic notes, and prescriber attestation of continued necessity. California advantage: If Humana denies renewal, file an Independent Medical Review (IMR) through DMHC—72% overall success

How Long Does It Take to Get Enbrel (etanercept) Approved by UnitedHealthcare in California? Complete Timeline & Milestones

Answer Box: Quick Timeline Overview Getting Enbrel (etanercept) approved by UnitedHealthcare in California typically takes 3-14 days for standard requests, 24-72 hours for urgent cases. The fastest path requires complete documentation upfront: diagnosis, failed DMARD trials, and specialist prescription. Start by having your rheumatologist submit the prior authorization through UnitedHealthcare&