Topic

California

A collection of 402 issues

Get Eylea and Lucentis Covered by Humana in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Started To get Eylea or Lucentis covered by Humana in California: First, check if your plan requires step therapy through bevacizumab (Avastin). If yes, document any prior anti-VEGF treatment failures or contraindications. Submit prior authorization via the Humana provider portal with OCT imaging, visual acuity measurements, and

How to Get Mepsevii (vestronidase alfa-vjbk) Covered by Aetna (CVS Health) in California: Prior Authorization Guide and Appeal Process

Answer Box: Getting Mepsevii Covered by Aetna (CVS Health) in California Mepsevii (vestronidase alfa-vjbk) requires prior authorization from Aetna with strict medical necessity criteria. Success requires: (1) confirmed MPS VII diagnosis via enzyme assay or genetic testing, (2) elevated urinary GAGs ≥2× normal, and (3) prescription by a metabolic specialist.

How to Get Tavalisse (Fostamatinib) Covered by Aetna CVS Health in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Tavalisse Approved by Aetna CVS Health in California Aetna CVS Health requires prior authorization for Tavalisse (fostamatinib) with strict step therapy criteria including documented failure of corticosteroids, IVIG, and TPO receptor agonists. Your fastest path: Have your hematologist submit a complete PA request via the Aetna provider

How to Get Entresto (sacubitril/valsartan) Covered by Aetna (CVS Health) in California: Complete Prior Authorization Guide

Answer Box: Getting Entresto Covered by Aetna (CVS Health) in California Entresto (sacubitril/valsartan) requires prior authorization from Aetna (CVS Health) on most 2024-2025 California plans. Fastest path: Submit the California-specific PA form with complete heart failure documentation (LVEF ≤40%, NYHA class, prior ACE/ARB history) via Aetna's

How to Get Hemlibra (emicizumab-kxwh) Covered by Cigna in California: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Hemlibra Covered by Cigna in California Cigna requires prior authorization for Hemlibra (emicizumab-kxwh) as a Tier 4 specialty drug for hemophilia A prophylaxis. Submit the dedicated Hemlibra PA form via Cigna's provider portal with hemophilia A diagnosis (ICD-10 D66), recent FVIII inhibitor titer (Bethesda assay

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

Answer Box: Quick Path to Coverage Cigna requires prior authorization for Vitrakvi (larotrectinib) in California, with approval typically within 5 business days when complete documentation is submitted. Your oncologist must provide NTRK fusion test results, treatment history, and medical necessity justification. If denied, California's Independent Medical Review (IMR)

Daybue (Trofinetide) Approval with Humana in California: Complete Coverage and Appeals Guide

Answer Box: Quick Path to Daybue Coverage Yes, Humana covers Daybue (trofinetide) in California as a specialty-tier medication requiring prior authorization. For fastest approval: (1) Have your neurologist/geneticist submit a PA request with confirmed Rett syndrome diagnosis and MECP2 genetic testing results, (2) Use Humana's provider portal

Get Chenodal (Chenodiol) Covered by Cigna in California: Prior Authorization Guide & Appeal Scripts

Quick Answer: Getting Chenodal Covered by Cigna in California Cigna requires prior authorization for Chenodal (chenodiol) with specific imaging documentation of radiolucent gallstones and proof you're not a surgical candidate. The fastest path: have your doctor submit a PA request with ultrasound/KUB reports showing radiolucent stones, surgical

Krystexxa (Pegloticase) Approval with UnitedHealthcare in California: Answers to the Most Common Questions

Answer Box: Getting Krystexxa Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Krystexxa (pegloticase) in California with strict step therapy requiring documented failure of both allopurinol and febuxostat at maximum doses, plus G6PD testing and rheumatologist oversight. Submit PA via UnitedHealthcare provider portal with complete clinical documentation. If

How to Get Ocrevus (Ocrelizumab) Covered by UnitedHealthcare in California: Renewal Guide, Appeal Scripts, and Timeline

Answer Box: Getting Ocrevus Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Ocrevus (ocrelizumab) with annual renewal documentation showing clinical response. Submit via the UHC Provider Portal with MS diagnosis confirmation, prior DMT trials, and evidence of treatment benefit (stable/improved disability scores, reduced relapses, or MRI stability)