Topic

California

A collection of 429 issues

How to Get Enhertu Covered by Aetna CVS Health in California: Prior Authorization Guide and Appeal Process

Answer Box: Getting Enhertu Covered by Aetna CVS Health in California Enhertu (fam-trastuzumab deruxtecan-nxki) requires prior authorization from Aetna CVS Health for HER2-positive breast cancer, NSCLC, and gastric cancer. Your fastest path to approval: 1) Gather HER2 test results and prior therapy records, 2) Submit PA request via Availity portal

Work With Your Doctor to Get Elfabrio (pegunigalsidase alfa-iwxj) Covered by Blue Cross Blue Shield in California: Complete Provider Partnership Guide

Quick Answer: Your Path to Elfabrio Coverage Getting Elfabrio (pegunigalsidase alfa-iwxj) covered by Blue Cross Blue Shield in California requires strong physician partnership and thorough documentation. Your doctor must demonstrate confirmed Fabry disease with genetic testing, document any failed prior treatments, and submit comprehensive prior authorization with clinical justification. If

How Long Does It Take to Get Idelvion Approved by Blue Cross Blue Shield in California? Timeline & Appeal Guide

Answer Box: Getting Idelvion Covered by Blue Cross Blue Shield in California Timeline: Standard prior authorization takes 5-7 business days; expedited requests process within 24-48 hours. Fastest path: Submit complete documentation through Blue Shield's online portal with lab results showing factor IX deficiency, bleeding history, and medical necessity

How to Get Elevidys Covered by Blue Cross Blue Shield in California: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Elevidys Covered by Blue Cross Blue Shield in California Blue Shield of California requires prior authorization for Elevidys (delandistrogene moxeparvovec), the gene therapy for Duchenne Muscular Dystrophy. Key requirements: confirmed DMD genetic testing, ambulatory status (ages 4-5), stable corticosteroid regimen, and administration at a certified center. First

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

Answer Box: Getting Pyrukynd (mitapivat) Covered by Aetna CVS Health in California Aetna CVS Health requires prior authorization for Pyrukynd (mitapivat) based on genetic confirmation of pyruvate kinase deficiency (≥2 PKLR variants with ≥1 missense), hemoglobin ≤10 g/dL or transfusion history, and hematologist prescribing. If denied, California residents can

How to Get Tavneos (Avacopan) Covered by UnitedHealthcare in California: Complete Appeals Guide with Templates

Answer Box: Getting Tavneos Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Tavneos (avacopan) with strict criteria: severe active ANCA-associated vasculitis (GPA/MPA), use alongside standard therapy (rituximab or cyclophosphamide plus steroids), and specialist prescriber. If denied, California residents can appeal through UnitedHealthcare's internal process, then

Getting Emgality (galcanezumab-gnlm) Covered by Humana in California: Prior Authorization, Appeals, and Cost Savings

Answer Box: Getting Emgality Covered by Humana in California Emgality (galcanezumab-gnlm) requires prior authorization from Humana and is typically placed on a high-tier formulary. Your fastest path to approval: have your doctor submit a PA request documenting your migraine diagnosis, failure of 2+ preventive medications, and medical necessity. If denied,

Get Kuvan (Sapropterin) Covered by Humana in California: Complete Prior Authorization Guide

Answer Box: Getting Kuvan Covered by Humana in California Kuvan (sapropterin dihydrochloride) requires prior authorization for all Humana plans in California. Your fastest path to approval: (1) Have your prescriber submit the Humana Medicare Part D Prior Authorization Form with complete PKU documentation to fax 877-486-2621, (2) Include proof of

Renewing Vigabatrin (Sabril) Approval with Aetna CVS Health in California: Timeline, Documents & What to Prepare

Answer Box: Vigabatrin Renewal with Aetna CVS Health in California Vigabatrin (Sabril) prior authorization renewal with Aetna CVS Health requires documentation of continued seizure response (≥50% reduction from baseline), ongoing REMS program compliance with vision monitoring every 3 months, and submission 30-60 days before current approval expires. Start by gathering

How to Get Uptravi (Selexipag) Covered by Blue Cross Blue Shield in California: Complete Requirements Guide

Answer Box: Getting Uptravi Covered by Blue Cross Blue Shield California Uptravi (selexipag) requires prior authorization from Blue Cross Blue Shield of California for WHO Group I pulmonary arterial hypertension. To get approved: (1) Submit clinical documentation proving PAH diagnosis with right heart catheterization data, (2) Include 6-minute walk test