Topic

California

A collection of 402 issues

How to Get Takhzyro (lanadelumab-flyo) Covered by Blue Cross Blue Shield California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Takhzyro Covered by Blue Cross Blue Shield California Blue Cross Blue Shield California requires prior authorization for Takhzyro (lanadelumab-flyo) for hereditary angioedema (HAE). To get approved: (1) Your doctor submits a PA request with HAE diagnosis confirmation (low C4/C1-INH labs), attack frequency logs, and failed step
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How to Get Gattex (Teduglutide) Covered by UnitedHealthcare in California: Appeals, Forms & Timelines

Answer Box: Getting Gattex Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Gattex (teduglutide) with strict medical necessity criteria: documented short bowel syndrome, ≥12 months of parenteral nutrition dependence (≥3 days/week), recent colonoscopy, and specialist involvement. If denied, California residents can appeal internally, then request an Independent
6 min read

How to Get Lutathera Covered by Humana in California: Prior Authorization Forms, Appeal Process & Success Strategies

Answer Box: Getting Lutathera Covered by Humana in California Lutathera (lutetium Lu-177 dotatate) requires prior authorization from Humana and is covered under Medicare Part B as a medical benefit. Key requirements include SSTR-positive PET imaging and documented failure/progression on somatostatin analogs like octreotide or lanreotide. If denied, California residents
7 min read

How to Get Daybue (trofinetide) Covered by Blue Cross Blue Shield California: Forms, Appeals, and State Protections

Answer Box: Getting Daybue Covered in California Blue Shield of California requires prior authorization for Daybue (trofinetide) with specific clinical criteria: confirmed Rett syndrome with MECP2 mutation, age ≥2 years, and neurologist prescriber. Initial approval covers 3 months, renewals require evidence of clinical benefit. If denied, California's Independent
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How to Get Vanflyta (quizartinib) Covered by Cigna in California: Complete Guide with Appeals Process

Quick Answer: Getting Vanflyta Covered by Cigna in California Eligibility: Adults ≥18 with newly diagnosed FLT3-ITD–positive AML. Fastest approval path: Submit prior authorization with confirmed FLT3-ITD lab report, baseline EKG showing QTcF ≤450ms, and treatment plan specifying induction/consolidation/maintenance phases. First step today: Contact your oncologist to order
5 min read

Renewing Filspari (Sparsentan) Coverage with Blue Cross Blue Shield in California: Complete 2024 Guide with Timelines and Forms

Answer Box: Renewing Filspari Coverage in California Blue Shield of California requires quarterly renewal documentation for Filspari (sparsentan), including updated proteinuria labs, liver function tests per REMS requirements, and nephrologist attestation of clinical benefit. Start renewal 30-45 days before expiration. Submit via AuthAccel portal with current UPCR, eGFR, and LFTs.
5 min read