Topic

California

A collection of 492 issues

How to Get Brineura (Cerliponase Alfa) Covered by UnitedHealthcare in California: Appeals Guide with Forms and Timelines

Answer Box: Getting Brineura Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Brineura (cerliponase alfa) with strict CLN2 disease criteria. If denied, California residents can file an Independent Medical Review (IMR) through the DMHC with a 55-70% overturn rate for specialty drugs. First step today: Gather CLN2 diagnosis
5 min read

Work With Your Doctor to Get Tecentriq (Atezolizumab) Approved by UnitedHealthcare in California: Complete Provider Collaboration Guide

Answer Box: Getting Tecentriq Approved by UnitedHealthcare in California UnitedHealthcare requires prior authorization (PA) for Tecentriq (atezolizumab) through OptumRx, with specific clinical documentation including PD-L1 testing, biomarkers, and prior treatment history. The fastest path: 1) Submit PA via UnitedHealthcare Provider Portal with complete clinical evidence, 2) Request peer-to-peer review if
6 min read

How to Get Imbruvica (Ibrutinib) Covered by Humana in California: Prior Authorization Forms, Appeals Timeline, and State Protections

Answer Box: Getting Imbruvica Covered by Humana in California Humana Medicare Advantage plans in California typically require prior authorization for Imbruvica (ibrutinib), with 72-hour response times for urgent cases. If denied, California's Independent Medical Review (IMR) overturns 55-68% of specialty drug denials. Start today: Call Humana Clinical Pharmacy
6 min read

Myths vs. Facts: Getting Evkeeza (evinacumab-dgnb) Covered by UnitedHealthcare in California

Answer Box: Quick Facts About UnitedHealthcare Evkeeza Coverage in California Myth: If your doctor prescribes Evkeeza, UnitedHealthcare must cover it automatically. Fact: UnitedHealthcare requires prior authorization for Evkeeza (evinacumab-dgnb), including genetic or clinical confirmation of homozygous familial hypercholesterolemia (HoFH), documentation of prior lipid-lowering therapy trials, and specialist involvement. Most commercial
7 min read

How to Get Hemgenix (Etranacogene Dezaparvovec) Covered by UnitedHealthcare in California: ICD-10, HCPCS Codes, and Appeals Guide

Answer Box: Getting Hemgenix Covered in California UnitedHealthcare requires prior authorization for Hemgenix (etranacogene dezaparvovec) in California. The fastest path: (1) Submit PA through UHC provider portal with complete clinical documentation including ICD-10 D67, baseline Factor IX activity ≤2%, and negative inhibitor testing, (2) Ensure treatment at an approved hemophilia
6 min read

Get Tremfya (Guselkumab) Covered by Blue Cross Blue Shield in California: Prior Authorization Forms, Appeals, and Success Strategies

Answer Box: Fastest Path to Tremfya Approval Tremfya (guselkumab) requires prior authorization from Blue Cross Blue Shield in California for plaque psoriasis and psoriatic arthritis. First step: Have your dermatologist/rheumatologist complete TB screening and document prior therapy failures. Submit PA via fax (888-697-8122) or CoverMyMeds ePA. Standard approval takes
5 min read