Topic

California

A collection of 492 issues

If Enbrel Isn't Approved by Blue Cross Blue Shield in California: Formulary Alternatives & Exception Paths

Quick Answer: When Blue Cross Blue Shield Denies Enbrel in California If Blue Cross Blue Shield California denies Enbrel (etanercept), you have formulary alternatives and exception pathways. Most denials stem from step therapy requirements favoring adalimumab biosimilars or other TNF inhibitors. Your fastest options: 1) Try a preferred alternative like

How to Get Cresemba (Isavuconazole) Covered by Aetna CVS Health in California: Prior Authorization Forms, Appeals, and Success Strategies

Answer Box: Getting Cresemba Approved by Aetna CVS Health in California Quick Path to Approval: Aetna CVS Health requires prior authorization for Cresemba (isavuconazole) in California. Your fastest route: (1) Confirm your plan type (HMO vs PPO affects appeal rights), (2) Submit PA with diagnosis codes B44.x (aspergillosis) or

How to Get Venclexta (venetoclax) Approved by Humana in California: Timeline, Appeals & Prior Authorization Guide

Answer Box: Getting Venclexta Approved by Humana in California Yes, Humana covers Venclexta (venetoclax) for CLL/SLL and AML, but requires prior authorization. The fastest path: 1) Have your oncologist submit a complete PA with diagnosis, prior treatments, TLS monitoring plan, and baseline labs via Humana's electronic portal,

Lowering Out-of-Pocket Costs for Procysbi with UnitedHealthcare in California: Copay Cards, Tier Exceptions & Appeals

Answer Box: Getting Procysbi Covered by UnitedHealthcare in California UnitedHealthcare covers Procysbi (cysteamine bitartrate DR) for nephropathic cystinosis but requires prior authorization and step therapy with immediate-release cysteamine first. Procysbi is typically placed on Tier 4 specialty with higher cost-sharing. First step: Have your specialist document any failure, intolerance, or

How to Get Jaypirca (pirtobrutinib) Covered by Cigna in California: Prior Authorization Guide with Appeals Process

Answer Box: Getting Jaypirca Covered by Cigna in California Eligibility: Jaypirca (pirtobrutinib) requires prior authorization for relapsed/refractory mantle cell lymphoma or CLL/SLL after BTK inhibitor failure. Fastest path: Submit PA through Accredo with complete BTK inhibitor failure documentation. First step today: Call Cigna member services to confirm Accredo

How to Get Koselugo (selumetinib) Covered by Aetna (CVS Health) in California: Complete Prior Authorization Guide with Forms and Appeals

Answer Box: Getting Koselugo (selumetinib) Covered by Aetna (CVS Health) in California Who's eligible: Pediatric patients (≥1 year) with neurofibromatosis type 1 (NF1) and symptomatic, inoperable plexiform neurofibromas. Fastest approval path: Submit prior authorization via CVS Caremark portal with complete NF1 documentation, baseline cardiac/eye exams, and surgical

How to Get Crysvita (Burosumab) Covered by UnitedHealthcare in California: Complete Prior Authorization Guide with ICD-10 and Appeals

Answer Box: Getting Crysvita Covered by UnitedHealthcare in California Crysvita (burosumab) requires prior authorization from UnitedHealthcare OptumRx. Submit PA requests through the UnitedHealthcare Provider Portal with genetic testing (PHEX mutation or elevated FGF23), documented failure of oral phosphate/calcitriol therapy, and endocrinologist involvement. If denied, file an internal appeal within

The Complete Requirements Checklist to Get Gattex (teduglutide) Covered by Blue Cross Blue Shield in California

Answer Box: Fast Track to Gattex Coverage Blue Shield of California requires prior authorization for Gattex (teduglutide) for patients with parenteral-nutrition-dependent short bowel syndrome. Submit PA through the Provider Connection portal with SBS diagnosis confirmation, PN dependence documentation, and clinical evidence. If denied, file an internal appeal within plan timelines,

How to Get Bavencio (Avelumab) Covered by Cigna in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Bavencio (Avelumab) Covered by Cigna in California Cigna requires prior authorization for Bavencio (avelumab) in California. Submit the Bavencio PA form via fax (855-840-1678) or online at CoverMyMeds. Include diagnosis (ICD-10), prior platinum therapy records for urothelial cancer, and recent imaging (≤8 weeks). Standard approval takes 5

How to Get Gattex (teduglutide) Covered by Cigna in California: Appeals, Forms, and Success Strategies

Answer Box: Getting Gattex Covered by Cigna in California Cigna requires prior authorization for Gattex (teduglutide) with strict documentation of short bowel syndrome and parenteral nutrition dependence ≥3 days/week. Submit through Express Scripts with surgical reports, 30-day PN logs, failed enteral nutrition attempts, and gastroenterologist consultation. If denied, file