Topic

California

A collection of 429 issues

How to Get Darzalex Covered by Blue Cross Blue Shield in California: Appeals Guide & Medical Necessity Templates

Quick Answer: Getting Darzalex Approved by Blue Cross Blue Shield in California Blue Cross Blue Shield California requires prior authorization for Darzalex (daratumumab) in 2024. To get coverage: (1) Your oncologist submits a prior authorization request with complete documentation of your multiple myeloma diagnosis and prior treatments, (2) If denied,

How to Get Epidiolex (Cannabidiol) Covered by Cigna in California: Prior Authorization Guide and Appeals Process

Answer Box: Fastest Path to Epidiolex Coverage To get Epidiolex (cannabidiol) covered by Cigna in California, you need: 1) Confirmed diagnosis of LGS, Dravet syndrome, or TSC by a neurologist, 2) Documentation of failed trials with 2+ other seizure medications, and 3) Prior authorization submitted by your doctor. Cigna must

How to Get Amvuttra (vutrisiran) Approved by Aetna CVS Health in California: Formulary Alternatives, PA Requirements & Appeal Scripts

Answer Box: Getting Amvuttra Covered by Aetna CVS Health in California Aetna CVS Health requires prior authorization for Amvuttra (vutrisiran) with documented genetic testing, specialist evaluation, and evidence of failure/intolerance to preferred alternatives like tafamidis or patisiran. In California, standard PA decisions take 72 hours; urgent requests get 24-hour

Coding That Helps Get Idelvion (albutrepenonacog alfa) Approved by UnitedHealthcare in California: ICD-10, J-Code, and NDC Guide

Answer Box: Getting Idelvion Covered by UnitedHealthcare in California Idelvion (albutrepenonacog alfa) requires prior authorization from UnitedHealthcare with specific coding: Use ICD-10 code D67 (hereditary factor IX deficiency), HCPCS J7202 (1 IU per billing unit), and the correct NDC for your vial strength. Submit clinical documentation showing hemophilia B diagnosis,

How to Get Tagrisso (osimertinib) Covered by UnitedHealthcare in California: Prior Authorization, Appeals & Cost Assistance

Answer Box: Getting Tagrisso Covered by UnitedHealthcare in California Quick answer: Tagrisso requires prior authorization from UnitedHealthcare but has $0 copay for covered patients. To get approved: (1) Submit PA with EGFR mutation test results through your doctor, (2) If denied, file internal appeal within 180 days, (3) Request California

How to Get Hemlibra (Emicizumab) Covered by UnitedHealthcare in California: Complete Guide to Forms, Appeals, and Approval

Quick Answer: Getting Hemlibra Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Hemlibra (emicizumab-kxwh) in California. The fastest path: Your doctor submits a PA request through the UnitedHealthcare Provider Portal with clinical documentation showing hemophilia A diagnosis and inhibitor status. If denied, file an internal appeal within 180

How to Get Bylvay (odevixibat) Covered by UnitedHealthcare in California: Forms, Timelines & Appeal Scripts

Answer Box: Fastest Path to Bylvay Coverage Bylvay (odevixibat) is covered on UnitedHealthcare's California HMO formulary as Tier 3 with prior authorization required. To get approved: 1) Ensure your gastroenterologist or hepatologist submits PA documentation including genetic PFIC diagnosis (or confirmed Alagille syndrome), moderate-to-severe pruritus, failure of two

How to Get Ofev (nintedanib) Covered by Aetna CVS Health in California: Prior Authorization Guide and Appeals Process

Answer Box: Getting Ofev (nintedanib) Covered by Aetna CVS Health in California Ofev (nintedanib) is covered by Aetna CVS Health as a Tier 4 specialty drug with strict prior authorization requirements. You'll need HRCT showing ≥10% lung fibrosis, recent PFTs (FVC ≥45% predicted), and evidence of disease progression

Get Elevidys Covered by UnitedHealthcare in California: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Elevidys Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Elevidys (delandistrogene moxeparvovec-rokl) gene therapy for DMD. The fastest path to approval involves three key steps: (1) Submit a complete PA request through the UnitedHealthcare Provider Portal with genetic confirmation, anti-AAVrh74 antibody results ≤1:400, and

Myths vs. Facts: Getting Helixate (antihemophilic factor, rFVIII) Covered by Aetna (CVS Health) in California

Answer Box: Helixate Coverage Through Aetna (CVS Health) in California Helixate (recombinant factor VIII) requires prior authorization from Aetna (CVS Health) and may face coverage challenges due to product discontinuation in the US. Alternative rFVIII products like Kovaltry or Jivi are typically covered with proper documentation. In California, if denied,