Topic

California

A collection of 492 issues

How Long Does It Take to Get Sumavel DosePro (Sumatriptan Injection, Needle-Free) Approved by Humana in California? Complete Timeline Guide

Quick Answer: Sumavel DosePro Approval Timeline with Humana in California Getting Sumavel DosePro (sumatriptan injection, needle-free) approved by Humana in California typically takes 7-14 days for standard prior authorization, or 72 hours for expedited requests when health is at risk. The fastest path: gather documentation of failed oral triptans, submit

How to Get Humira (adalimumab) Covered by Aetna (CVS Health) in California: Complete 2025 Guide with Forms and Appeals

Answer Box: Fastest Path to Humira Coverage with Aetna in California Aetna requires prior authorization for Humira (adalimumab) with step therapy to preferred biosimilars first. To get coverage: 1) Submit PA via CVS Caremark ePA portal with specialist prescription, TB/hepatitis B screening, and documented biosimilar failures, 2) If denied,

Humana's Coverage Criteria for Vyndaqel/Vyndamax (Tafamidis) in California: What Counts as "Medically Necessary"?

Getting Vyndaqel/Vyndamax (tafamidis) covered by Humana in California requires confirmed ATTR-CM diagnosis via PYP scan (Grade 2-3) or biopsy, NYHA Class I-III heart failure, and cardiology oversight. Submit prior authorization with diagnostic reports, clinical notes, and specialist documentation through Humana's provider portal. If denied, file internal appeal

How to Get Soliris (Eculizumab) Covered by Cigna in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Soliris Covered by Cigna in California Cigna requires prior authorization for Soliris (eculizumab) across all FDA-approved indications in California. The fastest path to approval: (1) Ensure meningococcal vaccinations are completed ≥2 weeks before treatment, (2) Have your specialist submit the PA through Cigna's provider portal

Renewing Elevidys (Delandistrogene Moxeparvovec-Rokl) Approval with Aetna CVS Health in California: What to Prepare & When

Answer Box: Elevidys Renewal Essentials Elevidys (delandistrogene moxeparvovec-rokl) is a one-time gene therapy, so traditional "renewal" doesn't apply. However, California DMD families may need ongoing coverage for monitoring labs, cardiac assessments, and potential complications. Start preparing 90 days before your plan year changes by documenting treatment

How to Get Tegsedi (inotersen) Covered by Cigna in California: Complete Guide with Forms, Appeals, and IMR Process

Answer Box: Your Fastest Path to Tegsedi Coverage Tegsedi (inotersen) requires prior authorization through Cigna in California. Your prescriber must submit a PA request via the EviCore portal or call 1-800-882-4462 with genetic testing confirmation, REMS enrollment proof, and specialist prescription. If denied, file an internal appeal within 180 days,

How to Get Rinvoq (Upadacitinib) Covered by Humana in California: Appeals Guide, Forms & State Protections

Answer Box: Getting Rinvoq Covered by Humana in California Rinvoq (upadacitinib) requires prior authorization from Humana in California, with typical denials for step therapy requirements or insufficient medical necessity documentation. Your fastest path to approval: 1. Verify coverage: Check Humana's formulary at humana.com/medicare/part-d-drug-plans for your

How to Get Orfadin (nitisinone) Covered by Blue Cross Blue Shield in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Orfadin Covered by Blue Cross Blue Shield in California Blue Cross Blue Shield plans in California require prior authorization for Orfadin (nitisinone) as a specialty drug, with coverage limited to confirmed hereditary tyrosinemia type 1 (HT-1) at doses ≤2 mg/kg per day. Your fastest path to

How to Get Waylivra (Volanesorsen) Covered by Aetna CVS Health in California: Forms, Appeals, and Success Strategies

Answer Box: Getting Waylivra Covered by Aetna CVS Health in California Waylivra (volanesorsen) requires a medical exception request with Aetna CVS Health since it's not FDA-approved or on standard formularies. California patients must document confirmed familial chylomicronemia syndrome (FCS) via genetic testing, triglycerides >875 mg/dL, and

Getting Strimvelis Gene Therapy Covered by Blue Cross Blue Shield in California: Complete Coding, Appeals, and Authorization Guide

Quick Answer: Getting Strimvelis Covered by Blue Cross Blue Shield in California Blue Cross Blue Shield plans in California require prior authorization for Strimvelis (autologous CD34+ gene therapy for ADA-SCID), administered only at SR-TIGET in Milan, Italy. Use ICD-10 code D81.31 (severe combined immunodeficiency due to adenosine deaminase deficiency)