Topic

California

A collection of 239 issues

How Long Does It Take to Get Enbrel (etanercept) Approved by UnitedHealthcare in California? Complete Timeline & Milestones

Answer Box: Quick Timeline Overview Getting Enbrel (etanercept) approved by UnitedHealthcare in California typically takes 3-14 days for standard requests, 24-72 hours for urgent cases. The fastest path requires complete documentation upfront: diagnosis, failed DMARD trials, and specialist prescription. Start by having your rheumatologist submit the prior authorization through UnitedHealthcare&
6 min read

Aetna CVS Health Coverage for Besponsa (Inotuzumab Ozogamicin) in California: Medical Necessity Requirements and Appeal Process

Quick Answer: Getting Besponsa Covered by Aetna CVS Health in California Aetna requires prior authorization for Besponsa (inotuzumab ozogamicin) with strict medical necessity criteria: CD22-positive B-cell ALL diagnosis, relapsed/refractory status, and hepatic monitoring plan. Submit PA through CVS Specialty at 1-888-267-3277. If denied, California patients have strong appeal rights
5 min read

How to Get Ilaris (Canakinumab) Covered by Humana in California: Prior Authorization Guide and Appeal Process

Quick Answer: Getting Ilaris (Canakinumab) Covered by Humana in California Humana requires prior authorization for Ilaris (canakinumab) with step therapy documentation and medical necessity justification. If denied, California residents have strong appeal rights through the DMHC Independent Medical Review (IMR) process with a 73% success rate. Start today: Have your
5 min read

How to Get Evrysdi (risdiplam) Covered by Aetna (CVS Health) in California: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Evrysdi Covered in California Getting Evrysdi (risdiplam) covered by Aetna (CVS Health) in California requires prior authorization with genetic confirmation of SMA, baseline motor assessments, and specialist prescription. If denied, California's robust appeal protections give you strong reversal odds—about 68% of specialty drug appeals
6 min read

Lowering Out-of-Pocket for Thiola / Thiola EC (tiopronin) with UnitedHealthcare in California: Copay, Tiering & Assistance

Answer Box: Getting Thiola Covered by UnitedHealthcare in California Fastest path to approval: UnitedHealthcare requires prior authorization for Thiola/Thiola EC with documented cystinuria diagnosis (ICD-10 E72.01), 24-hour urine cystine >250mg/day, specialist involvement, and failed conservative therapy. Submit through OptumRx portal with complete clinical documentation. If denied,
6 min read

How to Get Onpattro (Patisiran) Covered by UnitedHealthcare in California: Complete Coding, Appeals, and IMR Guide

Answer Box: Getting Onpattro (Patisiran) Covered by UnitedHealthcare in California Onpattro (patisiran) requires prior authorization from UnitedHealthcare OptumRx for hereditary transthyretin amyloidosis polyneuropathy (hATTR-PN). Key requirements: genetic confirmation of pathogenic TTR mutation, neurologist evaluation, and proper ICD-10 coding (E85.1). If denied, file internal appeal within 60 days, then escalate
5 min read