Topic

California

A collection of 492 issues

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

Answer Box: Get Krystexxa Covered by Aetna CVS Health in California Krystexxa (pegloticase) requires prior authorization from Aetna CVS Health for chronic gout patients who've failed allopurinol AND febuxostat. Submit complete documentation including G6PD test results, prior therapy records, and rheumatologist notes via medical benefit (J2507). If denied,

Lowering Out-of-Pocket for Opsumit (macitentan) with UnitedHealthcare in California: Copay, Tiering & Assistance

Answer Box: Getting Opsumit Covered by UnitedHealthcare in California Opsumit (macitentan) requires prior authorization from UnitedHealthcare and is classified as a specialty medication with step therapy requirements. The fastest path to approval involves: (1) having your PAH specialist submit a prior authorization through the UnitedHealthcare provider portal with complete clinical

How to Get Dupixent (dupilumab) Covered by Cigna in California: Complete Prior Authorization Guide with Forms and Appeal Scripts

Quick Answer: Getting Dupixent Covered by Cigna in California Cigna requires prior authorization for Dupixent (dupilumab) with specific medical necessity criteria. For atopic dermatitis, you'll need documented failure of topical corticosteroids and calcineurin inhibitors. For eosinophilic asthma, blood eosinophil count ≥150 cells/μL and failed high-dose ICS/LABA

How to Get Arikayce Covered by Cigna in California: Prior Authorization Requirements and Appeal Process

Answer Box: Getting Arikayce Covered by Cigna in California Cigna requires prior authorization for Arikayce (amikacin liposome inhalation) with strict criteria: adults ≥18 with MAC lung disease, positive cultures after ≥6 months of multidrug therapy, and amikacin susceptibility testing. Submit PA through Cigna/Express Scripts portal with sputum culture results,

Work With Your Doctor to Get Elaprase (idursulfase) Covered by Cigna in California: Complete Provider Collaboration Guide

Answer Box: Getting Elaprase (idursulfase) Covered by Cigna in California Cigna requires prior authorization for Elaprase (idursulfase) with standard approval in 5 business days. Submit via CoverMyMeds or Cigna's provider portal with enzymatic/genetic confirmation of Hunter syndrome (MPS II), weight-based dosing calculations (0.5 mg/kg weekly)

How to Get Cosentyx (Secukinumab) Covered by Blue Cross Blue Shield in California: Prior Authorization Guide and Appeals Process

Quick Answer: Getting Cosentyx Covered by Blue Cross Blue Shield in California Cosentyx (secukinumab) is a preferred IL-17 inhibitor on Blue Shield of California formularies but requires prior authorization with step therapy through TNF inhibitors first. To get coverage: (1) Submit PA documentation including diagnosis codes, prior therapy failures, and

How to Renew Prolastin-C Coverage with Humana in California: Complete Timeline and Documentation Guide

Answer Box: Renewing Prolastin-C Coverage with Humana in California Humana Medicare Advantage plans require prior authorization renewal for Prolastin-C every 6-12 months. Start your renewal 4-6 weeks early by gathering updated AAT levels (<11 µM within 12 months), recent lung function tests (FEV₁), and CT imaging confirming ongoing emphysema.

How to Get Busulfex (Busulfan Injection) Covered by Humana in California: Decision Tree & Appeals Guide

Answer Box: Getting Busulfex (Busulfan Injection) Covered by Humana in California Eligibility: Busulfex requires prior authorization from Humana for chronic myeloid leukemia (CML) conditioning before stem cell transplant. Fastest approval path: Have your transplant center submit a medical benefit PA request via Humana's provider portal with complete documentation

How to Get Myozyme (Alglucosidase Alfa) Covered by UnitedHealthcare in California: Complete PA Guide & Appeal Process

Answer Box: Getting Myozyme Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Myozyme (alglucosidase alfa) with confirmed Pompe disease diagnosis via genetic testing and enzyme assay, plus specialist evaluation. Submit through the UHC Provider Portal with complete documentation. If denied, file internal appeal within 180 days, then request

How to Get Kesimpta (Ofatumumab) Covered by UnitedHealthcare in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Kesimpta Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Kesimpta (ofatumumab) through OptumRx, with step therapy mandating documented failure of preferred MS treatments first. Submit PA via the UHC Provider Portal or fax to 1-844-403-1027. If denied, file internal appeals within 180 days, then request