Topic

California

A collection of 429 issues

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

How to Get Turalio (Pexidartinib) Covered by Humana in California: Prior Authorization Guide

Answer Box: Getting Turalio Covered by Humana in California Turalio (pexidartinib) requires prior authorization from Humana and is typically placed on Tier 5 (specialty tier). To get approved in California: 1. Complete REMS enrollment - Both prescriber and patient must enroll in the Turalio REMS Program 2. Submit comprehensive PA

How to Get Arikayce Covered by Humana in California: Prior Authorization Guide and Appeal Process

Quick Answer: Getting Arikayce Covered by Humana in California Humana requires prior authorization for Arikayce (amikacin liposome inhalation) with strict documentation of refractory MAC lung disease. Your fastest path to approval: 1) Gather 6+ months of failed standard therapy records, 2) Submit PA request with detailed medical necessity letter through

How to Get Orkambi (lumacaftor/ivacaftor) Covered by Cigna in California: Appeals Timeline and Documentation Guide

Answer Box: Getting Orkambi Covered by Cigna in California Fastest Path: Submit prior authorization with genetic test results showing F508del homozygosity, CF diagnosis documentation, and specialist prescription. If denied, file internal appeal within 180 days, then request California Independent Medical Review (IMR) through DMHC. Success rate for IMR appeals is

Blue Cross Blue Shield California Tecentriq Coverage: Medical Necessity Requirements and Appeal Process

Answer Box: Getting Tecentriq Covered by Blue Cross Blue Shield California Tecentriq (atezolizumab) requires prior authorization from Blue Cross Blue Shield California and is covered as a Tier 4 specialty drug for FDA-approved cancer indications. The fastest path to approval: 1) Confirm your diagnosis meets FDA-approved uses, 2) Submit a

How to Get Isturisa (Osilodrostat) Covered by Aetna CVS Health in California: Forms, Appeals, and Alternatives

Answer Box: Getting Isturisa Covered by Aetna CVS Health in California Isturisa (osilodrostat) is non-formulary on Aetna CVS Health Standard plans for 2025, requiring a medical exception request with strong clinical documentation. Your fastest path: 1) Have your endocrinologist submit a prior authorization with UFC test results and surgical history,

How to Get Kalydeco (ivacaftor) Approved by Humana in California: Timeline, Appeals, and Documentation Guide

Answer Box: Getting Kalydeco (ivacaftor) Covered by Humana in California Fastest path to approval: Submit prior authorization with CFTR genotype testing, specialist consultation, and diagnosis confirmation. Humana typically responds within 72 hours for standard requests, 24 hours for expedited. If denied, you have 65 days to appeal and can request