Topic

California

A collection of 241 issues

How to Get Soliris (Eculizumab) Covered by Humana in California: Complete Prior Authorization Guide

Answer Box: Getting Soliris Covered by Humana in California Humana requires prior authorization for Soliris (eculizumab) in California, with strict clinical criteria based on FDA-approved indications. Your fastest path to approval: 1) Confirm your diagnosis meets FDA criteria (PNH, aHUS, gMG, or NMOSD) with supporting lab work, 2) Submit a

How to Get Breyanzi (Lisocabtagene Maraleucel) Covered by Cigna in California: Complete Requirements Guide

Quick Answer: Getting Breyanzi Covered by Cigna in California To get Breyanzi (lisocabtagene maraleucel) covered by Cigna in California, you'll need prior authorization through their specialty pharmacy partner Express Scripts/Accredo. The fastest path: (1) Submit complete PA documentation including FDA-approved indication criteria, prior therapy failures, and REMS

How to Get Kineret (anakinra) Covered by Blue Cross Blue Shield in California: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Kineret Covered in California Kineret (anakinra) requires prior authorization from Blue Cross Blue Shield California and is placed on the specialty tier. For rheumatoid arthritis, you must first try two preferred agents (like Humira or Enbrel) and methotrexate unless contraindicated. If denied, California offers a strong Independent

Work With Your Doctor to Get Photrexa Covered by Cigna in California: Complete Appeals Guide

Answer Box: Getting Photrexa Covered by Cigna in California Fastest path to approval: Work with your ophthalmologist to submit a prior authorization (PA) request with documented keratoconus progression evidence—specifically Kmax increase ≥1.0 diopter and serial corneal topography. If denied, file an internal appeal within 180 days, then request

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

Answer Box: Getting Bylvay Covered by Blue Cross Blue Shield in California Yes, Blue Cross Blue Shield covers Bylvay (odevixibat) in California for FDA-approved uses—pruritus in PFIC and Alagille syndrome—but requires prior authorization with specialist documentation. The fastest path to approval: 1) Have a hepatologist or gastroenterologist submit

How to Get Humate-P Covered by Cigna in California: 2024 Forms, Appeal Scripts & Timeline

Answer Box: Getting Humate-P Covered by Cigna in California Humate-P (antihemophilic factor/vWF complex) requires prior authorization from Cigna, managed through Accredo Specialty Pharmacy. The fastest path to approval: (1) Have your hematologist submit the Cigna Hemophilia Factor VIII CCRD Prior Authorization Form with VWF:RCo and FVIII:C lab

The Requirements Checklist to Get Bavencio (avelumab) Covered by Blue Cross Blue Shield in California

Answer Box: Getting Bavencio Covered by Blue Cross Blue Shield in California Bavencio (avelumab) requires prior authorization from Blue Cross Blue Shield in California for metastatic Merkel cell carcinoma and urothelial carcinoma. Your fastest path to approval: 1) Gather complete diagnosis records and prior treatment history, 2) Submit the PA

How to Get Tremfya (Guselkumab) Covered by Aetna CVS Health in California: Prior Authorization, Appeals & Cost Savings

Answer Box: Fast Track to Tremfya Coverage Getting Tremfya (guselkumab) covered by Aetna CVS Health in California requires prior authorization through a dermatologist or rheumatologist. Submit documentation showing moderate-to-severe disease (≥10% body surface area or crucial areas affected) plus failure/intolerance of conventional treatments. First step: Have your specialist complete

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

Quick Answer: Getting Rapivab Covered by Blue Cross Blue Shield in California Blue Shield of California requires prior authorization for Rapivab (peramivir) with strict criteria: symptoms ≤48 hours, documented intolerance to oral antivirals (Tamiflu, Relenza, Xofluza), and positive flu test. Submit PA via fax with clinical documentation. If denied, file

Blue Cross Blue Shield California Prior Authorization for Thiola / Thiola EC (Tiopronin): Complete Coverage Guide with Appeal Scripts

Answer Box: Getting Thiola / Thiola EC Covered in California Blue Cross Blue Shield of California requires prior authorization for Thiola / Thiola EC (tiopronin), with approval based on documented cystinuria diagnosis, failed conservative therapy, and ongoing medical necessity. Your fastest path to approval: (1) Gather 24-hour urine cystine results >500