Topic

California

A collection of 429 issues

How to Get Sumavel DosePro Covered by Cigna in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Sumavel DosePro Covered by Cigna in California The fastest path to approval: Cigna requires prior authorization and step therapy documentation showing oral triptan failures before covering Sumavel DosePro. First step today: Have your doctor gather records of failed oral triptan trials and submit a PA request through

How to Get Onpattro (Patisiran) Covered by Humana in California: Prior Authorization Guide with Appeals Process

Answer Box: Getting Onpattro (Patisiran) Covered by Humana in California Onpattro (patisiran) requires prior authorization from Humana in California. Your fastest path to approval: (1) Confirm genetic testing shows a pathogenic TTR variant and neurologist has documented hATTR-PN, (2) Submit Humana's "Request for Medicare Prescription Drug Coverage

How to Get Duopa Covered by Humana in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Duopa Covered by Humana in California Duopa (carbidopa/levodopa enteral) requires prior authorization from Humana Medicare Advantage plans in California. To get approved: (1) Submit PA request via Availity portal or call 1-866-488-5995 with complete clinical documentation showing advanced Parkinson's disease with motor fluctuations and

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

Quick Answer: Getting Evrysdi Approved by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Evrysdi (risdiplam) with strict criteria: confirmed SMN1 gene mutation, no invasive ventilation dependency, and no concurrent Spinraza use. Submit through the UnitedHealthcare Provider Portal with genetic testing, motor function assessments (CHOP INTEND/HFMSE), and specialist documentation.

How to Get Synagis (Palivizumab) Covered by Humana in California: Complete Authorization Guide

Answer Box: Getting Synagis (Palivizumab) Covered by Humana in California Quick Path to Approval: Synagis requires prior authorization from Humana Medicare Advantage plans for high-risk pediatric patients during RSV season (November-March). Your pediatric cardiologist or pulmonologist must submit complete documentation proving your child meets specific criteria: premature birth ≤35 weeks,

Get Xenpozyme (Olipudase Alfa) Covered by UnitedHealthcare in California: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Xenpozyme Covered by UnitedHealthcare in California Xenpozyme (olipudase alfa-rpcp) requires prior authorization from UnitedHealthcare and is typically covered under the medical benefit for ASMD (Niemann-Pick disease types A/B). Key requirements: confirmed ASMD diagnosis with enzyme assay showing <10% ASM activity, genetic testing showing two pathogenic

How to Get Mavenclad (Cladribine) Covered by Blue Cross Blue Shield in California: Complete Guide with Appeal Scripts

Answer Box: Getting Mavenclad Covered in California To get Mavenclad (cladribine) covered by Blue Cross Blue Shield in California: (1) Meet prior authorization criteria including relapsing MS diagnosis, failed 2+ preferred DMTs, and normal lymphocyte counts, (2) Submit complete documentation via your neurologist including medical necessity letter and prior therapy

Complete Guide: Getting Elfabrio (Pegunigalsidase Alfa-iwxj) Covered by Cigna in California - Requirements, Appeals & Templates

Quick Answer: Getting Elfabrio Covered by Cigna in California Eligibility: Adults with confirmed Fabry disease diagnosed via enzyme assay or genetic testing. Fastest path: Submit prior authorization through CoverMyMeds with complete clinical documentation. First step today: Gather diagnostic confirmation (enzyme levels or GLA gene testing), prior therapy records, and current

If Nourianz (Istradefylline) Isn't Approved by UnitedHealthcare in California: Formulary Alternatives & Exception Paths

Answer Box: Nourianz Alternatives & Exception Paths If UnitedHealthcare denies Nourianz (istradefylline) in California, you'll typically need to try formulary alternatives first through step therapy. Preferred options include amantadine, MAO-B inhibitors (rasagiline/selegiline), or COMT inhibitors (entacapone/tolcapone). Document treatment failures or contraindications carefully—this evidence becomes crucial

How to Get Helixate (Antihemophilic Factor) Covered by Blue Cross Blue Shield in California: PA Forms, Appeals, and Approval Strategies

Answer Box: Quick Path to Coverage Helixate (antihemophilic factor, rFVIII) requires prior authorization from Blue Cross Blue Shield in California. While the original Helixate FS was discontinued by Bayer in 2022-2023, alternative recombinant factor VIII products are available through specialty pharmacy networks. Your fastest path: 1) Have your hematologist submit