By Counterforce Health Team in Keppra (levetiracetam) —

How to Get Keppra (Levetiracetam) Covered by Cigna in Pennsylvania: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Keppra (Levetiracetam) Covered by Cigna in Pennsylvania

Most Cigna plans in Pennsylvania cover generic levetiracetam without prior authorization, but brand Keppra typically requires a formulary exception showing medical necessity. Your fastest path: Have your doctor submit a prior authorization through CoverMyMeds with documentation that generic versions failed or caused adverse effects. If denied, Pennsylvania's new external review program has overturned roughly 50% of appealed denials in 2024. Start today: Call Cigna at 1-800-997-1654 to verify your plan's specific requirements and get the process moving.

Table of Contents

  1. Verify Your Plan Coverage
  2. Prior Authorization Forms and Submission
  3. Medical Necessity Documentation
  4. Specialty Pharmacy Transfer Process
  5. Appeals Process: Internal and External
  6. Contact Information and Support
  7. Pennsylvania External Review Program
  8. Common Denial Reasons and Solutions
  9. Costs and Financial Assistance
  10. FAQ

Verify Your Plan Coverage

Before starting any authorization process, confirm your specific Cigna plan requirements for Keppra (levetiracetam).

Coverage at a Glance

Requirement What It Means Where to Find It Source
Generic levetiracetam Usually covered without PA Cigna formulary Cigna Drug Lists
Brand Keppra Requires formulary exception Prior auth needed Cigna PA Forms
Step therapy May require generic trial first Plan documents Coverage policies
Quantity limits Varies by strength/formulation Member portal myCigna account
Tip: Log into your myCigna account or call 1-800-997-1654 to check your specific formulary tier and any restrictions before your doctor submits paperwork.

Prior Authorization Forms and Submission

Cigna strongly prefers electronic prior authorization submissions through CoverMyMeds, which typically processes requests faster than fax or phone submissions.

Step-by-Step: Electronic PA Submission

  1. Doctor accesses CoverMyMeds Cigna portal
  2. Complete patient information: Cigna member ID, diagnosis codes, medication details
  3. Upload supporting documents: Clinical notes, prior therapy records, lab results
  4. Submit electronically - no fax required
  5. Track status through the CoverMyMeds dashboard
  6. Expect response within 5 business days for standard requests

Alternative Submission Methods

  • Phone: 1-800-882-4462 (1-800-88-CIGNA) for urgent requests
  • EHR Integration: SureScripts-enabled systems can submit directly
  • Fax: Use only if electronic submission unavailable - forms available on Cigna's PA resource page

Medical Necessity Documentation

Clinician Corner: Building a Strong Case

For brand Keppra approval, your medical necessity letter should include:

Required Clinical Elements:

  • Primary diagnosis with ICD-10 code (epilepsy, seizure disorder)
  • Prior generic levetiracetam trial with specific dates and outcomes
  • Documented failure reasons: lack of efficacy, adverse events, or contraindications
  • Current seizure control status and treatment goals
  • Dosing rationale and monitoring plan

Supporting Evidence to Include:

  • FDA labeling information for levetiracetam
  • Relevant epilepsy treatment guidelines
  • Laboratory results or imaging supporting the diagnosis
  • Documentation of other failed anti-seizure medications
From our advocates: We've seen the strongest approvals when doctors clearly document that a patient was stable on brand Keppra but experienced breakthrough seizures when switched to generic, with specific dates and seizure frequency changes. This continuity-of-care argument often resonates with reviewers.

Specialty Pharmacy Transfer Process

If your Cigna plan requires specialty pharmacy dispensing, you'll need to transfer to Accredo, Cigna's specialty pharmacy partner.

Enrollment Steps:

  1. Call Accredo at 877-826-7657 (Mon-Fri 7am-10pm, Sat 7am-4pm CST)
  2. Have ready: Cigna ID card, doctor's contact info, current prescription details
  3. Timeline: Call 2 weeks before your next refill
  4. Online option: Access through myCigna app under "Prescriptions" tab

Benefits of Accredo:

  • 24/7 pharmacist support
  • Free specialty shipping
  • Medication counseling and administration training
  • Copay assistance program navigation
Note: Beginning January 1, 2026, most specialty prescriptions will automatically transfer to Accredo, but you can initiate the transfer earlier if needed.

Appeals Process: Internal and External

Cigna Internal Appeals

First Level Internal Appeal

  • Deadline: 180 days from denial notice
  • Review time: 15 business days (72 hours for expedited)
  • Submit via: myCigna portal, phone, or written request
  • Required: Original denial letter, additional medical records, prescriber statement

Second Level Internal Appeal

  • Automatically initiated if first appeal denied
  • Additional timeline: 15 business days
  • Independent reviewer: Not involved in original decision

Formulary Exception Process

For brand-over-generic requests, your physician must demonstrate that generic levetiracetam is:

  • Ineffective for your specific condition
  • Detrimental or caused adverse events
  • Contraindicated due to other medical conditions

Exception Timeline:

  • Standard review: 72 hours
  • Expedited review: 24 hours (for urgent medical need)

Pennsylvania External Review Program

Pennsylvania launched its Independent External Review Program in January 2024, providing a powerful tool for overturning insurance denials.

Key Statistics:

  • 50% success rate - 259 out of 517 cases ruled in favor of patients
  • Timeline: 45 days for standard review, 72 hours for expedited
  • Cost: Free to Pennsylvania residents

Eligibility Requirements:

  1. Complete Cigna's internal appeals process first
  2. Receive Final Adverse Benefit Determination letter
  3. Submit within 4 months of final denial
  4. Plan cannot be self-insured (check with HR)

How to Submit:

  • Online: Pennsylvania Insurance Department External Review Portal
  • By mail: Pennsylvania Insurance Department, External Review Program
  • Supporting documents: Can be submitted within 15 days of IRO assignment

Counterforce Health specializes in helping patients navigate these complex appeal processes by turning insurance denials into targeted, evidence-backed appeals. The platform analyzes denial letters and plan policies to identify the specific denial basis and drafts point-by-point rebuttals aligned with the payer's own rules.

Contact Information and Support

Member Services

  • 24/7 Customer Service: 1-800-997-1654
  • TTY/TDD: Dial 711
  • Live Chat: Mon-Fri 9am-8pm ET via myCigna account
  • Claims Address: Cigna Healthcare, PO Box 5200, Scranton, PA 18505

Provider Relations

  • Prior Authorization: 1-800-882-4462
  • Precertification Fax: 1-866-873-8279
  • Provider Portal: CignaForHCP.com

Pennsylvania Resources

  • PA Insurance Department: Consumer Services line (check pa.gov for current number)
  • Pennsylvania Health Law Project: Free appeals assistance
  • Pennie Marketplace: Consumer hotline for marketplace plans

Common Denial Reasons and Solutions

Denial Reason How to Overturn Required Documentation
Generic available Medical necessity letter Prior generic failure, adverse events
Not formulary Formulary exception request Clinical justification, guideline support
Step therapy Override request Documentation of required steps completed
Quantity limits Limit override Dosing rationale, clinical monitoring plan
Experimental/investigational Medical necessity appeal Published studies, FDA approval status

Costs and Financial Assistance

Manufacturer Support:

  • UCB (original Keppra manufacturer) may offer patient assistance programs
  • Check manufacturer websites for current copay cards or foundation grants

Generic Options:

  • Generic levetiracetam typically costs under $20 for 60 tablets at many pharmacies
  • Compare prices using GoodRx or similar platforms

Pennsylvania State Programs:

  • PACE/PACENET for seniors
  • Medicaid coverage for eligible residents

FAQ

How long does Cigna prior authorization take in Pennsylvania? Standard PA requests are typically processed within 5 business days through CoverMyMeds. Expedited requests can be approved within 24-72 hours if there's urgent medical need.

What if Keppra is not on Cigna's formulary? You can request a formulary exception with medical necessity documentation. Your doctor must demonstrate why formulary alternatives are inappropriate for your specific condition.

Can I request an expedited appeal in Pennsylvania? Yes, both Cigna's internal appeals and Pennsylvania's external review program offer expedited pathways when delay would jeopardize your health.

Does step therapy apply if I was stable on Keppra before moving to Pennsylvania? Continuity of care provisions may apply. Document your stable treatment history and any adverse events from switching medications.

What happens if Pennsylvania's external review overturns Cigna's denial? Cigna must provide coverage immediately, including retroactive coverage if you paid out-of-pocket during the appeal process.

For patients facing complex coverage challenges, Counterforce Health helps turn insurance denials into successful appeals by identifying denial patterns and crafting evidence-backed responses that align with each payer's specific requirements.

Sources & Further Reading

Disclaimer: This information is for educational purposes only and does not constitute medical or legal advice. Always consult with your healthcare provider and insurance plan for specific coverage decisions. Coverage policies and procedures may vary by plan and can change over time.

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