Topic

California

A collection of 240 issues

How to Get Juxtapid (lomitapide) Covered by Humana in California: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Getting Juxtapid (lomitapide) Covered by Humana in California Juxtapid requires prior authorization from Humana with strict clinical documentation. Key requirements include genetic confirmation of homozygous familial hypercholesterolemia (HoFH), documented failure or intolerance to maximum-dose statins and ezetimibe, enrollment in the REMS program, and dispensing through certified specialty pharmacies
7 min read

How to Get Koselugo (Selumetinib) Covered by Blue Cross Blue Shield in California: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Koselugo Covered by Blue Cross Blue Shield in California Koselugo (selumetinib) requires prior authorization from Blue Cross Blue Shield in California but is generally covered when FDA criteria are met. The fastest path: 1) Gather NF1 diagnosis, imaging showing inoperable plexiform neurofibromas, and baseline cardiac/eye exams,
6 min read

How to Get Vanflyta (Quizartinib) Covered by Aetna CVS Health in California: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Vanflyta Covered by Aetna CVS Health in California Vanflyta (quizartinib) requires prior authorization from Aetna CVS Health for FLT3-ITD positive AML. Key requirements: confirmed FLT3-ITD mutation via FDA-approved test, baseline EKG with QTc ≤450ms, and oncologist prescription. If denied, California residents can appeal internally within 180 days,
6 min read

How to Get Vitrakvi (Larotrectinib) Covered by UnitedHealthcare in California: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Vitrakvi Covered by UnitedHealthcare in California Vitrakvi (larotrectinib) requires prior authorization through OptumRx for UnitedHealthcare members in California. To get approved: (1) Submit NTRK fusion test results via the UHC provider portal, (2) document prior therapies or contraindications for step therapy exception, and (3) include oncologist notes
5 min read