Topic

California

A collection of 46 issues

How to Get Venclexta (venetoclax) Covered by Aetna CVS Health in California: Forms, Appeals & Resources

Answer Box: Getting Venclexta Covered by Aetna CVS Health in California Venclexta (venetoclax) requires prior authorization from Aetna CVS Health. The fastest path to approval: 1) Have your doctor submit the Aetna Prior Authorization Form with diagnosis (CLL/SLL or AML), prior treatment failures, and clinical justification. 2) Enroll with

Get Busulfex (Busulfan Injection) Covered by Cigna in California: Appeals Guide and Provider Collaboration

Answer Box: Your Fastest Path to Approval Busulfex (busulfan injection) typically doesn't require prior authorization from Cigna for medically necessary use in transplant conditioning regimens. However, if denied, California patients have strong appeal rights with a 72% success rate through Independent Medical Review (IMR). Take action today: 1)

Coding That Helps Get Oxervate (cenegermin) Approved by UnitedHealthcare in California: ICD-10, HCPCS, and NDC Guide

Answer Box: Getting Oxervate Covered by UnitedHealthcare in California Oxervate (cenegermin) requires prior authorization from UnitedHealthcare with specific coding requirements. Use ICD-10 codes H16.231-H16.233 for stage 2/3 neurotrophic keratitis, HCPCS code J3590, and NDC 71923-019-01. Submit through OptumRx with documented artificial tear failure and ophthalmologist prescription. If

How Long Does It Take to Get Lutathera Approved by Cigna in California? Complete Timeline & Appeal Guide

Answer Box: Lutathera Approval Timeline in California Getting Lutathera (lutetium Lu-177 dotatate) approved by Cigna in California typically takes 3-7 days for standard prior authorization, or 24 hours for expedited requests when your doctor documents urgent medical need. California law requires Cigna to respond within 72 hours for standard requests

Renewing Hemgenix Coverage with Blue Cross Blue Shield in California: Annual Requirements and Timeline

Answer Box: Blue Shield of California requires annual reauthorization for Hemgenix (etranacogene dezaparvovec) gene therapy. Start renewal 60-90 days before your authorization expires. Submit updated clinical documentation showing ongoing eligibility, Factor IX levels, bleeding episodes, liver function tests, and provider attestation through Blue Shield's AuthAccel portal or designated

How to Get Trikafta Covered by Humana in California: Complete Prior Authorization Guide

Answer Box: Getting Trikafta Covered by Humana in California Trikafta requires prior authorization from Humana in California. The fastest path: (1) Confirm your F508del or responsive mutation with genetic testing, (2) Have your CF specialist submit a medical necessity letter with documentation to Humana at 877-486-2621, and (3) If denied,

Do You Qualify for Kuvan (Sapropterin) Coverage by Aetna CVS Health in California? Decision Tree & Next Steps

Answer Box: Your Path to Kuvan Coverage Kuvan (sapropterin) is covered by Aetna CVS Health as a specialty medication with prior authorization required. Most PKU patients qualify if they have confirmed diagnosis, demonstrate BH4-responsiveness (≥20% phenylalanine reduction), and maintain dietary management under specialist care. Fastest approval path: 1. Your metabolic

Work With Your Doctor to Get Retevmo (selpercatinib) Covered by Humana in California: Templates, Timelines & Appeal Scripts

Quick Answer: Getting Retevmo (selpercatinib) Covered by Humana in California Humana Medicare Advantage requires prior authorization for Retevmo (selpercatinib) for RET fusion-positive cancers. Your oncologist must submit documentation proving RET alteration status through Evolent's portal or by calling 844-926-4528. If denied, you have 65 days to appeal and

If Zanzalintinib (XL092) Isn't Approved by UnitedHealthcare in California: Formulary Alternatives & Exception Paths

Answer Box: Getting Zanzalintinib (XL092) Covered by UnitedHealthcare in California Zanzalintinib (XL092) is investigational and typically not covered by UnitedHealthcare outside clinical trials. Your fastest paths: 1) Request compassionate use through Exelixis (drug provided free), 2) Try covered multi-target TKI alternatives like cabozantinib or lenvatinib with prior authorization, or 3)

How to Get Xywav (Ca/Mg/K/Na oxybates) Covered by Cigna in California: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Xywav Covered by Cigna in California Cigna requires prior authorization for Xywav with strict criteria: confirmed narcolepsy/idiopathic hypersomnia diagnosis, sleep studies, specialist prescription, failed dextroamphetamine trial, and REMS enrollment. First step: Have your sleep specialist submit PA request with complete documentation to Cigna/Express Scripts. If