Topic

California

A collection of 492 issues

Myths vs. Facts: Getting Spinraza (nusinersen) Covered by UnitedHealthcare in California

Quick Answer: UnitedHealthcare requires prior authorization for Spinraza (nusinersen) for spinal muscular atrophy patients in California. Success depends on genetic confirmation of 5q SMA, neurologist prescription, and no concurrent SMN-modifying therapies. If denied, California's Independent Medical Review overturns 55-69% of specialty drug denials. Start by gathering genetic testing

How to Get Spinraza (Nusinersen) Covered by Humana in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Spinraza (Nusinersen) Covered by Humana in California Spinraza (nusinersen) requires prior authorization from Humana Medicare Advantage/Part D, with approval based on genetic confirmation of 5q SMA, neurologist prescription, and baseline motor function testing. Submit the Request for Medicare Prescription Drug Coverage Determination form via Humana'

How to Get Trikafta Covered by Blue Cross Blue Shield of California: Complete Prior Authorization and Appeals Guide 2025

Answer Box: Getting Trikafta Covered by Blue Cross Blue Shield of California Blue Cross Blue Shield of California requires prior authorization for Trikafta, including documented CFTR genotype testing showing sensitive mutations (like F508del), confirmed CF diagnosis, and patient age ≥2 years. Submit via AuthAccel portal or fax with genetic test

How to Get Cabometyx (Cabozantinib) Covered by Aetna CVS Health in California: Complete Prior Authorization Guide

Quick Answer: Getting Cabometyx Covered by Aetna CVS Health in California Cabometyx (cabozantinib) requires prior authorization from Aetna CVS Health for FDA-approved cancer indications. Your oncologist must submit clinical documentation including diagnosis codes (ICD-10), pathology reports, prior therapy failures, and recent imaging. California law requires decisions within 72 hours for

Myths vs. Facts: Getting Keppra (levetiracetam) Covered by Cigna in California

Answer Box: Getting Keppra (levetiracetam) Covered by Cigna in California Generic levetiracetam is typically covered on Cigna formularies, but may require prior authorization or have quantity limits. Brand Keppra requires "brand medically necessary" documentation due to generic preference policies. If denied, file an internal appeal with Cigna within

How to Get Nourianz (istradefylline) Covered by Aetna CVS Health in California: Prior Authorization Forms, Timelines, and State Appeal Rights

Answer Box: Getting Nourianz Covered by Aetna CVS Health in California Nourianz (istradefylline) requires prior authorization from Aetna CVS Health for Parkinson's disease OFF episodes. To get approved in California: (1) Submit PA form via Availity portal with documented OFF episodes ≥2 hours/day, concurrent levodopa/carbidopa use,

How to Get Exondys 51 (Eteplirsen) Covered by Aetna CVS Health in California: Prior Authorization Guide and Appeals Process

Answer Box: Fast Track to Approval To get Exondys 51 (eteplirsen) covered by Aetna CVS Health in California: Submit prior authorization with genetic testing confirming exon 51 amenable DMD mutation, specialist prescription, baseline functional assessments (6-minute walk test ≥300m), and corticosteroid trial documentation. If denied, file internal appeal within 21

How to Get Vanflyta (Quizartinib) Covered by Humana in California: Complete PA Guide with Appeals Process

Quick Answer: Getting Vanflyta Covered by Humana in California Vanflyta (quizartinib) is not on Humana's 2024 formulary, requiring a formulary exception with prior authorization (PA). Success requires: (1) Confirmed FLT3-ITD positive AML diagnosis with lab reports, (2) Documentation of medical necessity from a REMS-certified oncologist, (3) Baseline EKG

How to Get Tagrisso (osimertinib) Covered by Humana in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tagrisso (osimertinib) Covered by Humana in California Humana requires prior authorization for Tagrisso (osimertinib) with documented EGFR mutation testing and clinical justification. The fastest path: have your oncologist submit a complete prior authorization request through Humana's provider portal with EGFR test results, treatment history, and

Getting Oxbryta (Voxelotor) Covered by Blue Cross Blue Shield California: Complete Guide to Appeals After FDA Withdrawal

Answer Box: Oxbryta Coverage After FDA Withdrawal Oxbryta (voxelotor) was withdrawn from the U.S. market in November 2024, making new coverage requests extremely challenging. However, patients currently stable on Oxbryta may appeal denials through Blue Shield of California's internal process, then California's Independent Medical Review