Topic

California

A collection of 429 issues

How to Get Bavencio (Avelumab) Covered by Humana in California: Decision Tree, Appeals, and Next Steps

Answer Box: Your Fastest Path to Bavencio Coverage Humana requires prior authorization for Bavencio (avelumab) in California. Your eligibility depends on having FDA-approved indications: metastatic Merkel cell carcinoma or maintenance treatment for locally advanced/metastatic urothelial carcinoma after first-line platinum chemotherapy. Three steps to start today: 1. Confirm your diagnosis

How Long Does It Take to Get Turalio (Pexidartinib) Approved by Blue Cross Blue Shield in California? Complete Timeline & Appeals Guide

Answer Box: Getting Turalio Covered by Blue Cross Blue Shield in California Blue Cross Blue Shield of California requires prior authorization for Turalio (pexidartinib), with electronic submissions typically processed in 1-3 business days. The fastest path involves: (1) ensuring REMS enrollment for both prescriber and patient, (2) submitting complete clinical

Getting Gamifant (Emapalumab-lzsg) Covered by UnitedHealthcare in California: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Quick Path to Gamifant Coverage To get Gamifant (emapalumab-lzsg) covered by UnitedHealthcare in California: First, gather complete HLH-2004 diagnostic documentation and evidence of conventional therapy failure. Submit prior authorization through the UnitedHealthcare provider portal with detailed medical necessity letter. If denied, file internal appeal within 60 days, then

How to Get Uptravi (Selexipag) Covered by Humana in California: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Uptravi (Selexipag) Covered by Humana in California Humana requires prior authorization for Uptravi (selexipag) for pulmonary arterial hypertension (PAH). To get approved: 1) Have your PAH specialist complete Humana's prior authorization form with WHO Group I PAH diagnosis via right heart catheterization, 2) Document trials/

How to Get Xenpozyme (Olipudase Alfa) Covered by Cigna in California: Prior Authorization, Appeals, and IMR Success Strategies

Quick Answer: Xenpozyme (olipudase alfa-rpcp) requires prior authorization through Cigna's specialty pharmacy partner Accredo. You'll need confirmed ASMD diagnosis with enzyme testing, specialist prescription, and documented medical necessity. If denied, California's Independent Medical Review (IMR) has a 50-65% success rate for rare disease drugs.

How Long Does It Take to Get Vigabatrin (Sabril) Approved by Blue Cross Blue Shield in California? Complete Timeline Guide

Quick Answer: Getting vigabatrin (Sabril) approved by Blue Cross Blue Shield in California typically takes 5-7 business days for routine requests, or 24-48 hours for urgent cases. Success depends on complete REMS enrollment, baseline vision testing documentation, and meeting specific criteria for infantile spasms or refractory epilepsy. Start by ensuring

How to Get Eylea or Lucentis Covered by Cigna in California: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Eylea/Lucentis Covered by Cigna in California Your fastest path to approval: Submit prior authorization through CoverMyMeds or call Cigna at 1-800-882-4462 with complete clinical documentation. Include your diagnosis (wet AMD, diabetic macular edema), OCT/FFA imaging, prior treatments tried, and visual acuity measurements. If denied, you

Work With Your Doctor to Get Kymriah (tisagenlecleucel) Covered by Humana in California: Complete Guide

Answer Box: Getting Kymriah Covered by Humana in California Kymriah (tisagenlecleucel) requires prior authorization from Humana Medicare Advantage plans in California. The fastest path to approval: (1) Confirm treatment at a certified CAR-T center like City of Hope or Stanford, (2) Have your oncologist submit a complete prior authorization with

Getting Strimvelis Gene Therapy Covered by Humana in California: Complete Requirements Checklist and Appeals Guide

Answer Box: Fast Track to Coverage Strimvelis is not FDA-approved in the U.S. and only available at SR-TIGET in Milan, Italy. Humana Medicare doesn't cover international medical tourism or non-emergency overseas treatments. However, you can still pursue coverage through these steps: 1. Submit a prior authorization request

Renewing Voxzogo (Vosoritide) Approval with UnitedHealthcare in California: 2025 Requirements, Timeline & Bridge Options

Quick Answer: UnitedHealthcare requires annual prior authorization renewal for Voxzogo (vosoritide) with specific clinical documentation. Start the renewal process 60-90 days before expiration with updated growth data, proof of open growth plates, and provider attestation. If denied, California residents can file an Independent Medical Review (IMR) through the DMHC. BioMarin