Topic

California

A collection of 241 issues

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'

Renewing Translarna (Ataluren) Coverage with Humana in California: 2025 Requirements and Timeline

Answer Box: Renewing Translarna (Ataluren) with Humana in California Renewal Timeline: Submit renewal requests 30-60 days before your current prior authorization expires to avoid coverage gaps. Humana requires updated clinical documentation showing continued ambulatory function and treatment response. Key Requirements: 6-minute walk test results, current clinical notes, adherence documentation, and

Blue Cross Blue Shield California Coverage for Cystadane (Betaine Anhydrous): Prior Authorization Requirements and Appeal Guide

Answer Box: Getting Cystadane Covered by Blue Cross Blue Shield California Eligibility: Cystadane requires prior authorization with biochemical/genetic confirmation of homocystinuria (CBS, MTHFR, or cobalamin defects), documented vitamin therapy trials, and specialty pharmacy dispensing. Fastest path: Have your prescriber submit PA with genetic testing results, elevated homocysteine levels, and

Work With Your Doctor to Get Joenja (leniolisib) Approved by Blue Cross Blue Shield in California: Forms, Appeals, and Clinical Evidence

Answer Box: Getting Joenja (leniolisib) Approved in California Blue Cross Blue Shield California requires prior authorization for Joenja (leniolisib), with genetic testing documentation confirming APDS diagnosis. The fastest path: Your immunologist submits a PA request via the Blue Shield provider portal with genetic test results, clinical notes, and treatment history.

Work With Your Doctor to Get Ozempic and Mounjaro Covered by Blue Cross Blue Shield in California

Answer Box: Getting Started in California To get Ozempic or Mounjaro covered by Blue Cross Blue Shield in California: Your doctor must submit a prior authorization request with documented type 2 diabetes diagnosis, A1C levels, and proof you've tried metformin or other oral medications first. If denied, you

Do You Qualify for Opzelura (Ruxolitinib Cream) Coverage by Blue Cross Blue Shield in California? Decision Tree & Next Steps

Quick Answer: Getting Opzelura Covered by Blue Cross Blue Shield in California Yes, Opzelura (ruxolitinib cream) can be covered by Blue Cross Blue Shield plans in California, but prior authorization is required. You'll need documented failure of topical steroids or calcineurin inhibitors, confirmed diagnosis of atopic dermatitis or

How to Get Pomalyst (Pomalidomide) Covered by Blue Cross Blue Shield in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Pomalyst Covered by Blue Cross Blue Shield in California Blue Cross Blue Shield California requires prior authorization for Pomalyst (pomalidomide). To get approved: (1) Ensure your oncologist documents progression after ≥2 prior therapies including lenalidomide and a proteasome inhibitor, (2) Complete REMS program enrollment for prescriber, patient,

Blue Cross Blue Shield California Coverage for Acthar Gel: Medical Necessity Criteria, Prior Authorization, and Appeals Guide

Answer Box: Getting Acthar Gel Covered in California Blue Cross Blue Shield California requires prior authorization for Acthar Gel with documented failure of corticosteroids first. The fastest path: Have your doctor submit a PA request through the provider portal with complete clinical notes showing corticosteroid trial failure or contraindications. If

How to Get Aldurazyme (laronidase) Covered by Aetna CVS Health in California: Complete Prior Authorization & Appeal Guide

Quick Answer: Getting Aldurazyme Covered by Aetna CVS Health in California Aldurazyme (laronidase) requires prior authorization from Aetna CVS Health for all plan types in California. Coverage is approved for confirmed MPS I (Hurler, Hurler-Scheie, or moderate-to-severe Scheie forms) with enzyme/genetic testing documentation. The medication is placed on specialty

Getting Garadacimab (ANDEMBRY) Covered by Cigna in California: Complete 2025 Prior Authorization Guide

Quick Answer: Getting Garadacimab Covered by Cigna in California Yes, Cigna covers garadacimab (ANDEMBRY®) for hereditary angioedema prophylaxis in California, but prior authorization is required. The fastest path: gather HAE diagnosis labs (C4, C1-INH levels), document failed prior therapies, complete REMS training, and submit through Express Scripts' portal. If