Topic

California

A collection of 402 issues

How to Get Entresto (sacubitril/valsartan) Covered by UnitedHealthcare in California: Prior Authorization, Appeals, and Coding Guide

Answer Box: Getting Entresto Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Entresto (sacubitril/valsartan) in California, with approval typically taking 72 hours when proper documentation is submitted. Your fastest path: (1) Have your cardiologist submit a PA through the UHC provider portal with your heart failure diagnosis,

How to Get Koselugo (selumetinib) Covered by Humana in California: Complete Prior Authorization Guide

Quick Answer: Getting Koselugo Covered by Humana in California Koselugo (selumetinib) requires prior authorization from Humana for pediatric NF1 patients with symptomatic, inoperable plexiform neurofibromas. Your fastest path: 1) Have your specialist complete Humana's PA form via CoverMyMeds with NF1 diagnosis, imaging showing inoperable tumors, and baseline cardiac/

How to Get Qinlock (ripretinib) Covered by UnitedHealthcare in California: Forms, Appeals, and Step-by-Step Guide

Answer Box: Getting Qinlock Covered by UnitedHealthcare in California Quick Path to Approval: UnitedHealthcare requires prior authorization for Qinlock (ripretinib) in advanced GIST patients who've failed ≥3 kinase inhibitors including imatinib. Submit through the UnitedHealthcare Provider Portal with documented TKI failure history. If denied, file internal appeal within

How to Get Vimizim (Elosulfase Alfa) Covered by Cigna in California: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Vimizim Covered by Cigna in California Cigna requires prior authorization for Vimizim (elosulfase alfa) for MPS IVA patients in California. Success requires: (1) confirmed MPS IVA diagnosis via GALNS enzyme testing or genetic confirmation, (2) prescribing by a pediatric metabolic geneticist or specialist experienced in lysosomal storage

If Pombiliti Isn't Approved by Cigna in California: Formulary Alternatives & Exception Paths

Quick Answer: Your Options When Cigna Denies Pombiliti If Cigna denies Pombiliti (cipaglucosidase alfa-atga) in California, Lumizyme or Nexviazyme are typically covered as first-line enzyme replacement therapies for late-onset Pompe disease. Most patients must try one of these alternatives before Cigna will consider Pombiliti approval. First step: Have your neurologist

Work With Your Doctor to Get Berinert Covered by UnitedHealthcare in California: Provider Partnership Guide

Answer Box: Getting Berinert Covered by UnitedHealthcare in California Fast track to approval: Schedule a visit with an allergist or immunologist to document your HAE diagnosis, attack frequency, and failed treatments. Request they submit a medical necessity letter emphasizing FDA-approved indication and prior therapy failures. If denied, file an internal

How to Get Strensiq (asfotase alfa) Covered by Aetna (CVS Health) in California: Prior Authorization, Appeals, and Coverage Strategies

Answer Box: Getting Strensiq (asfotase alfa) Covered by Aetna (CVS Health) in California Fastest path to approval: Submit Aetna's 2025 Strensiq Precertification Form (fax 1-888-267-3277) with genetic testing confirming ALPL mutation, lab results showing persistently low alkaline phosphatase, radiographic evidence of bone disease, and medical records documenting pediatric-onset

Do You Qualify for Daybue (trofinetide) Coverage by UnitedHealthcare in California? Decision Tree & Next Steps

Answer Box: To get Daybue (trofinetide) covered by UnitedHealthcare in California, you need: (1) confirmed Rett syndrome diagnosis with MECP2 testing, (2) patient age ≥2 years, and (3) specialist attestation from neurology or genetics. Submit prior authorization through the UHC Provider Portal with clinical documentation. If denied, file internal appeal

How to Get Rystiggo (Rozanolixizumab-noli) Covered by Cigna in California: Prior Authorization Guide and Appeal Scripts

Answer Box: To get Rystiggo (rozanolixizumab-noli) covered by Cigna in California, you need confirmed AChR- or MuSK-positive generalized myasthenia gravis and documented failure of standard therapies (pyridostigmine, corticosteroids, immunosuppressants). Submit prior authorization through CignaForHCP.com with complete treatment history. If denied, California's Independent Medical Review (IMR) through DMHC

How to Get Fintepla (fenfluramine) Approved by UnitedHealthcare in California: Complete Timeline & Appeals Guide

Answer Box: Getting Fintepla Approved by UnitedHealthcare in California Timeline: UnitedHealthcare typically decides Fintepla prior authorization requests within 24-72 hours for complete submissions, with urgent cases processed in ≤24 hours. Fastest path: Submit electronic PA with complete REMS enrollment documentation, baseline echocardiogram, and detailed seizure history. First step today: Call