Topic

California

A collection of 492 issues

Getting Firdapse (Amifampridine) Approved by Humana in California: Complete Prior Authorization Guide with Appeal Strategies

Quick Answer: Getting Firdapse Approved by Humana in California Firdapse (amifampridine) requires prior authorization from Humana Medicare Advantage/Part D plans in California as a Tier 5 specialty drug. Your neuromuscular specialist must submit the PA request with confirmed LEMS diagnosis (anti-P/Q VGCC antibodies + EMG showing >60% CMAP

How to Get Lutathera Covered by Blue Cross Blue Shield in California: Complete Forms, Portal & Appeals Guide

Answer Box: Getting Lutathera Approved by Blue Cross Blue Shield California Blue Cross Blue Shield California requires prior authorization for Lutathera (lutetium Lu-177 dotatate) as a medical benefit drug for somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Submit requests via your oncologist through the AuthAccel online system or contact Evolent at

How to Get Kanuma (Sebelipase Alfa) Covered by Aetna CVS Health in California: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Kanuma Covered by Aetna CVS Health in California Kanuma (sebelipase alfa) requires prior authorization from Aetna CVS Health. To get approved in California: 1) Have your doctor submit a PA request with LAL-D diagnosis confirmation (enzyme testing or genetic results), clinical evidence of disease severity, and dosing

How to Get Adynovate (Antihemophilic Factor) Covered by Humana in California: Prior Authorization Guide and Appeal Process

Answer Box: Getting Adynovate Covered by Humana in California Adynovate (bdanocog alfa pegol) requires prior authorization from Humana in California. To get approval: 1) Your hematologist submits a medical necessity letter documenting severe hemophilia A (factor VIII <1%), bleeding history, and failed standard treatments via Humana's provider

How to Get StrataGraft Covered by Humana in California: Prior Authorization Guide, Appeal Forms & Resources

Answer Box: Getting StrataGraft Covered by Humana in California StrataGraft requires prior authorization from Humana for deep partial-thickness burns in adults 18+. Submit through your provider via the medical benefit pathway (not pharmacy) using HCPCS code J7353. If denied, file an internal appeal within 65 days, then request California'

Myths vs. Facts: Getting Dupixent (dupilumab) Covered by UnitedHealthcare in California - Appeals Guide

Answer Box: Getting Dupixent Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Dupixent (dupilumab) with step therapy requirements varying by condition. For atopic dermatitis, you need documented failure of two topical therapies. For asthma, you must show poor control plus eosinophilic phenotype or steroid dependence. If denied, California

How to Get Emflaza (Deflazacort) Covered by Humana in California: Complete Coding, Prior Authorization & Appeals Guide

Answer Box: Getting Emflaza Covered by Humana in California Emflaza (deflazacort) requires prior authorization from Humana and uses ICD-10 code G71.01 for Duchenne muscular dystrophy. Most approvals require documented failure of prednisone due to weight gain or behavioral issues. If denied, California residents can appeal through Humana's

How to Get Adynovate (bdanocog alfa pegol) Covered by Aetna (CVS Health) in California: Prior Authorization Guide and Appeals Process

Answer Box: Getting Adynovate Covered by Aetna (CVS Health) in California Aetna (CVS Health) requires prior authorization for Adynovate (bdanocog alfa pegol) with specific medical necessity criteria for hemophilia A patients. To get coverage approved: 1. Submit PA request via Aetna Provider Portal or call 1-855-240-0535 for urgent cases (72-hour

How to Get Elfabrio (pegunigalsidase alfa-iwxj) Covered by Aetna (CVS Health) in California: Complete Forms, Appeals & Contact Guide

Answer Box: Getting Elfabrio Covered by Aetna (CVS Health) in California Aetna (CVS Health) requires prior authorization for Elfabrio (pegunigalsidase alfa-iwxj) with confirmed Fabry disease diagnosis, specialist prescriber, and weight-based dosing documentation. Submit through CVS Specialty enrollment forms or Aetna provider portal. If denied, file internal appeal within 180 days,

How to Get Palynziq (pegvaliase-pqpz) Covered by Blue Cross Blue Shield in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Palynziq Covered in California Blue Cross Blue Shield (BCBS Association) requires prior authorization for Palynziq (pegvaliase-pqpz) in California, with coverage limited to PKU patients titrating to achieve blood phenylalanine ≤600 µmol/L. The fastest path: submit PA via provider portal with PKU diagnosis, current Phe levels, and