Topic

California

A collection of 241 issues

How to Get Firazyr (Icatibant) Covered by UnitedHealthcare in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Firazyr Covered by UnitedHealthcare in California Firazyr (icatibant) requires strict prior authorization from UnitedHealthcare for hereditary angioedema (HAE) treatment. You'll need confirmed HAE diagnosis (ICD-10: D84.1), specialist prescription, documented failure of preferred alternatives (like Berinert), and self-administration training proof. Generic icatibant is typically covered

Myths vs. Facts: Getting Skyrizi (Risankizumab) Covered by Humana in California

Answer Box: Skyrizi Coverage Through Humana in California Getting Skyrizi (risankizumab) covered by Humana requires prior authorization with step therapy documentation. Most patients must show failure or intolerance to TNF inhibitors first. The fastest path: have your doctor submit complete PA documentation including TB screening, prior therapy details, and medical

How to Get Alecensa (alectinib) Covered by Cigna in California: Forms, Appeals, and Contact Numbers

Quick Answer: Getting Alecensa (alectinib) Covered by Cigna in California Your doctor must submit a prior authorization request with ALK-positive test results and complete clinical documentation. In California, Cigna has 72 hours to respond to non-urgent requests (24 hours for urgent cases). If denied, you can appeal internally through Cigna,

How Long Does It Take to Get Nucala (Mepolizumab) Approved by Cigna in California? Complete Timeline & Appeals Guide

Quick Answer: Nucala (Mepolizumab) Approval Timeline with Cigna in California Standard timeline: 2-15 business days from complete submission. Cigna/Express Scripts typically responds within 2 business days for routine requests, up to 15 business days maximum under California law. Expedited reviews: 72 hours for urgent cases. Fastest path to approval:

Do You Qualify for Enbrel (Etanercept) Coverage by Cigna in California? Complete Decision Tree & Appeals Guide

Answer Box: Your Fastest Path to Enbrel Coverage Most Cigna California members can get Enbrel (etanercept) covered if they meet three key criteria: confirmed moderate-to-severe rheumatoid arthritis or psoriasis, failure of at least one conventional therapy, and completed TB/hepatitis B screening. First step today: Have your rheumatologist or dermatologist

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

Answer Box: Getting Pomalyst Covered by Humana in California Pomalyst (pomalidomide) requires prior authorization from Humana in California. The fastest path to approval involves three key steps: (1) Ensure your oncologist documents prior failure of both lenalidomide and a proteasome inhibitor, (2) Complete REMS program enrollment for prescriber, patient, and

Renewing Taltz (Ixekizumab) Approval with Aetna CVS Health in California: Complete Renewal Guide 2025

Answer Box: Renewing Your Taltz (Ixekizumab) Authorization Start renewal 2-4 weeks before expiration. Submit updated clinical notes showing continued benefit, current diagnosis (ICD code), and safety monitoring via Aetna's precertification fax (1-877-269-9916). If denied, file internal appeal within 180 days, then California Independent Medical Review (IMR) through DMHC.

Renewing Tagrisso (Osimertinib) Coverage with Cigna in California: Essential Timeline and Documentation Guide

Answer Box: Renewing Tagrisso Coverage with Cigna Cigna requires annual renewal of prior authorization for Tagrisso (osimertinib) in California. Start the renewal process 4-6 weeks before your current authorization expires. You'll need updated EGFR mutation documentation, current oncologist assessment showing treatment benefit, and recent imaging/labs. Submit through

How Long Does It Take to Get Synagis (Palivizumab) Approved by UnitedHealthcare in California? Complete Timeline Guide

Answer Box: Synagis Approval Timeline with UnitedHealthcare in California UnitedHealthcare requires prior authorization for Synagis (palivizumab) in California, with approval typically taking 1-7 business days for complete submissions. OptumRx's automated PreCheck system can approve eligible cases in approximately 29 seconds when all criteria are met. The fastest path:

Work With Your Doctor to Get Kineret (anakinra) Approved by UnitedHealthcare in California: Complete Guide

Answer Box: Getting Kineret Approved by UnitedHealthcare in California To get Kineret (anakinra) covered by UnitedHealthcare in California: Your doctor must document failed DMARD therapy for rheumatoid arthritis or confirm DIRA diagnosis, submit prior authorization through OptumRx, and avoid prescribing with other targeted immunomodulators. If denied, file an internal appeal