Topic

California

A collection of 427 issues

How to Get Tremfya (Guselkumab) Covered by Humana in California: Complete Requirements Checklist

Quick Answer: Getting Tremfya Covered by Humana in California Eligibility: Humana requires prior authorization for Tremfya (guselkumab) with documented moderate-to-severe plaque psoriasis (≥3% body surface area) or active psoriatic arthritis, plus failed topical therapy and negative TB screening. Fastest path: Submit Humana's PA form through their provider portal

How to Get iLink® Corneal Cross-Linking Covered by Aetna in California: Complete Prior Authorization Guide

Answer Box: Getting iLink® Covered by Aetna in California Aetna requires prior authorization for iLink® corneal cross-linking (CPT 0402T) for keratoconus in California. Submit your request through AetnaElectronicPrecert.com with documented corneal progression, failed conservative treatments, and corneal thickness ≥400μm. If denied, file an internal appeal within 180 days, then

How to Get Voydeya (Danicopan) Covered by Aetna CVS Health in California: Complete Appeals Guide

Answer Box: Getting Voydeya Covered by Aetna CVS Health in California Voydeya (danicopan) requires prior authorization from Aetna CVS Health and must be obtained through CVS Specialty Pharmacy. The fastest path to approval: 1) Have your hematologist submit a comprehensive PA request with PNH diagnosis by flow cytometry, evidence of

How to Get Increlex (mecasermin) Covered by Aetna (CVS Health) in California: Timeline, Requirements & Appeal Process

Quick Answer: Getting Increlex Approved by Aetna in California Aetna (CVS Health) requires strict prior authorization for Increlex (mecasermin) with specific lab values and diagnostic criteria. Your child must have severe primary IGF-1 deficiency with height ≤3 SD below normal, IGF-1 levels ≤3 SD below normal, and normal growth hormone

Renewing Taltz (Ixekizumab) Approval with UnitedHealthcare in California: Complete Renewal Guide 2025

Answer Box: Renewing Taltz (Ixekizumab) with UnitedHealthcare in California Quick Path to Renewal: Submit your Taltz renewal request 2-4 weeks before your current authorization expires. You'll need clinical notes showing treatment response, updated diagnosis codes, and confirmation you're not using other biologics. If denied, California residents

Coding That Helps Get Waylivra (volanesorsen) Approved in California with Blue Cross Blue Shield (ICD-10, HCPCS/J-Code, NDC)

Answer Box: Getting Waylivra Coded and Covered Waylivra (volanesorsen) requires precise coding for Blue Cross Blue Shield California approval. Use ICD-10 E78.3 (Hyperchylomicronemia) for familial chylomicronemia syndrome. Bill under J3490/J3590 (miscellaneous codes) for medical benefit or NDC 72063-013-01 for pharmacy benefit. Document genetic confirmation of FCS, triglyceride levels

How to Get Sumavel DosePro Covered by UnitedHealthcare in California: Complete Timeline, Forms & Appeals Guide

Answer Box: Getting Sumavel DosePro Covered by UnitedHealthcare in California Important Note: Sumavel DosePro has been discontinued by the manufacturer, but generic needle-free sumatriptan injections may be available. UnitedHealthcare typically requires prior authorization and step therapy (trying oral triptans first) for injectable sumatriptan products. In California, standard PA decisions take

How to Get Takhzyro (Lanadelumab-flyo) Approved by Humana in California: Timeline, Forms & Appeals Guide

Quick Answer: Getting Takhzyro Approved by Humana in California Takhzyro (lanadelumab-flyo) requires prior authorization from Humana with documented HAE type I/II diagnosis, attack frequency data, and specialist involvement. Timeline: 1-14 days for PA decision, 1-5 days for specialty pharmacy shipment after approval. If denied, California residents can appeal through

How to Get Exondys 51 (Eteplirsen) Covered by Cigna in California: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Exondys 51 Covered by Cigna in California Quick Path to Approval: Cigna requires genetic testing proving exon 51 amenability, specialist prescriber, and prior authorization through Express Scripts/Accredo. If denied, file internal appeal within 180 days, then request California Independent Medical Review (IMR) through DMHC. Success rates

Getting Vimizim (Elosulfase Alfa) Covered by Blue Cross Blue Shield in California: Complete Guide with Forms and Appeals

Answer Box: How to Get Vimizim Covered by Blue Cross Blue Shield in California Vimizim (elosulfase alfa) requires prior authorization from Blue Cross Blue Shield in California, with specific documentation of MPS IVA diagnosis and baseline functional measures. The fastest path: (1) Submit prior authorization through Blue Shield's