Topic

California

A collection of 402 issues

How to Get Mycapssa (Octreotide Oral) Covered by Humana in California: Complete Approval Guide

Quick Answer: Getting Mycapssa Approved by Humana in California Mycapssa (oral octreotide) requires prior authorization from Humana for acromegaly patients who previously responded to injectable somatostatin analogs. The fastest path: have your endocrinologist submit a complete PA request through Humana's provider portal with documented prior octreotide/lanreotide response,

A Realistic Arcalyst (rilonacept) Approval Scenario with Aetna (CVS Health) in California: From Request to Yes

Answer Box: Getting Arcalyst Approved by Aetna in California Yes, Arcalyst (rilonacept) can be covered by Aetna (CVS Health) in California. The fastest path: 1) Your cardiologist submits a complete prior authorization packet via Availity portal documenting recurrent pericarditis and failed NSAIDs/colchicine, 2) Aetna reviews within 15 business days,

How to Get Enhertu (Fam-Trastuzumab Deruxtecan-nxki) Covered by Cigna in California: Appeal Guide & Templates

Answer Box: Getting Enhertu Covered by Cigna in California Cigna requires prior authorization for Enhertu with documented HER2 biomarker testing per ASCO/CAP guidelines, diagnosis details, and prior therapy records. Submit via Cigna's oncology PA form or eviCore system. If denied, California's Independent Medical Review (IMR)

Renewing Jaypirca (Pirtobrutinib) Approval with Aetna CVS Health in California: Complete Timeline & Documentation Guide

Answer Box: Renewing Jaypirca Coverage with Aetna CVS Health Aetna CVS Health requires annual prior authorization (PA) renewal for Jaypirca (pirtobrutinib) in California. Start the renewal process 10-14 days before your current PA expires to avoid treatment gaps. Submit renewal through your oncologist's office via the Aetna provider

How to Get HyperHEP Covered by Cigna in California: A Real Patient's Journey from Denial to Approval

Answer Box: Getting HyperHEP (Hepatitis B Immune Globulin) Covered by Cigna in California HyperHEP requires prior authorization from Cigna, with approval based on documented post-exposure prophylaxis within 7 days of hepatitis B exposure. Submit through Cigna's provider portal with exposure details, immunity status, and CDC guideline citations. If

How to Get Vimizim (elosulfase alfa) Covered by Aetna (CVS Health) in California: Complete Prior Authorization and Appeals Guide

Getting Vimizim (elosulfase alfa) covered by Aetna (CVS Health) in California requires prior authorization with confirmed MPS IVA diagnosis, specialist prescription, and baseline functional assessments. Submit documentation via Aetna's provider portal or call 1-888-632-3862 for PA forms. If denied, file an internal appeal within 180 days, then request

How to Renew Bavencio (Avelumab) Coverage with Aetna CVS Health in California: 2025 Requirements & Timeline

Quick Answer: Renewing Your Bavencio Coverage To renew Bavencio (avelumab) with Aetna CVS Health in California, submit your continuation request at least 14 days before your next infusion using form GR-69328. You'll need recent imaging showing no disease progression, oncology notes confirming tolerability, and documentation of continuous months

How to Get Tagrisso (osimertinib) Covered by Blue Cross Blue Shield in California: Prior Authorization Forms, Appeal Process & Success Strategies

Answer Box: Getting Tagrisso Covered in California Blue Cross Blue Shield plans in California require prior authorization for Tagrisso (osimertinib) with documented EGFR mutations in NSCLC. Submit electronically via CoverMyMeds or the plan's provider portal with pathology reports showing EGFR testing results. If denied, file an internal appeal

Myths vs. Facts: Getting Onpattro (patisiran) Covered by Blue Cross Blue Shield in California

Answer Box: Onpattro Coverage with Blue Shield California Getting Onpattro (patisiran) covered by Blue Shield of California requires prior authorization with genetic TTR mutation proof, neurologist evaluation, and ICD-10 code E85.1 documentation. Submit via AuthAccel portal with clinical records showing hATTR polyneuropathy and functional status. If denied, file internal

How to Get Lamzede (Velmanase Alfa-Tycv) Approved by Cigna in California: Complete Prior Authorization Guide

Answer Box: Getting Lamzede Covered by Cigna in California Cigna requires prior authorization for Lamzede (velmanase alfa-tycv) in California. Submit via eviCore, CoverMyMeds, or Accredo's iAssist with confirmed alpha-mannosidosis diagnosis (enzyme/genetic testing), specialist letter, and clinical documentation. Standard review: 5 business days; expedited: 24 hours for urgent