Topic

California

A collection of 240 issues

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

Answer Box: Getting Krystexxa Covered by Humana in California Krystexxa (pegloticase) requires prior authorization for all Humana Medicare Advantage plans in California. The fastest path to approval: 1) Ensure you have a rheumatologist prescriber, documented failure of allopurinol and febuxostat, normal G6PD test results, and current methotrexate therapy (unless contraindicated)

How Long Does It Take to Get Haegarda Approved by Blue Cross Blue Shield in California? Timeline & Milestones

Answer Box: Getting Haegarda Approved in California Getting Haegarda (C1-esterase inhibitor, SC) approved by Blue Cross Blue Shield California typically takes 5-15 business days for initial review, plus 1-3 days for pre-submission preparation. The fastest path requires complete HAE diagnosis documentation (C1-INH levels, C4 levels, attack history) submitted through Blue

How Long Does It Take to Get Taltz (Ixekizumab) Approved by Blue Cross Blue Shield in California? Complete Timeline Guide

Answer Box: Getting Taltz (Ixekizumab) Covered by Blue Cross Blue Shield in California Standard timeline: 15 business days for prior authorization approval after complete submission. Blue Cross Blue Shield California requires specialist consultation, documented diagnosis (moderate-to-severe plaque psoriasis, psoriatic arthritis, or spondyloarthritis), and proof of inadequate response to first-line therapies.

Getting Orkambi (Lumacaftor/Ivacaftor) Covered by Blue Cross Blue Shield in California: Complete Guide to Prior Authorization and Appeals

Answer Box: Quick Path to Orkambi Coverage in California Orkambi (lumacaftor/ivacaftor) requires prior authorization from Blue Cross Blue Shield of California for patients with cystic fibrosis who are F508del homozygous. Success requires three key elements: genetic testing documentation, specialist prescription, and proper ICD-10 coding (E84.0-E84.9). If denied,

How to Get Humira (adalimumab) Covered by Cigna in California: 2025 Biosimilar Changes and Appeal Guide

Quick Answer: Getting Humira (adalimumab) Covered by Cigna in California Starting in 2025, Cigna's Express Scripts has removed brand-name Humira from most commercial formularies, favoring biosimilar alternatives at $0 copay through Accredo. To get Humira covered, you'll need a formulary exception with clinical documentation showing biosimilar

How to Get Keytruda (Pembrolizumab) Covered by Blue Cross Blue Shield California: Complete 2025 Guide

Answer Box: Getting Keytruda Covered in California Keytruda (pembrolizumab) requires prior authorization from Blue Cross Blue Shield California, with approval based on FDA indications and specific biomarker testing (PD-L1, MSI-H, or TMB-H). Your fastest path: 1) Ensure your doctor has complete biomarker test results matching your cancer type, 2) Submit

Renewing Givlaari (Givosiran) Approval with UnitedHealthcare in California: Complete 2025 Guide

Answer Box: To renew Givlaari (givosiran) with UnitedHealthcare in California, submit annual prior authorization 30-45 days before expiration with: (1) Recent ALA/PBG lab values, (2) documented attack reduction from baseline, (3) specialist attestation of ongoing medical necessity, and (4) liver function monitoring results. Use the UnitedHealthcare provider portal for

Getting Trikafta Covered by Blue Cross Blue Shield in California: Complete Guide to Prior Authorization and Appeals (2024)

Answer Box: Fastest Path to Trikafta Coverage Trikafta requires prior authorization from Blue Cross Blue Shield of California. You'll need CFTR genotype documentation, CF diagnosis with ICD-10 codes, and baseline liver function tests. Submit through Blue Shield's AuthAccel portal or fax the PA form. If denied,

Resources to Get Opfolda (miglustat) Approved with Blue Cross Blue Shield in California: Forms, Portals & Contacts

Answer Box: Getting Opfolda (miglustat) Covered by Blue Cross Blue Shield in California Opfolda (miglustat) requires prior authorization from Blue Cross Blue Shield of California. Submit through the Provider Connection portal or fax specialty drug PA forms to (888) 697-8122. Include complete clinical documentation showing the patient weighs ≥40kg, has

Myths vs. Facts: Getting Tavneos (avacopan) Covered by Humana in California

Answer Box: Getting Tavneos Covered by Humana in California Humana requires prior authorization for Tavneos (avacopan) with specific criteria: confirmed ANCA-associated vasculitis diagnosis, specialist prescriber (rheumatology/nephrology/pulmonology), and use as adjunctive therapy with standard treatments. First step today: Have your specialist submit a complete prior authorization through Humana'