Topic

Pennsylvania

A collection of 40 issues

If Jynarque (Tolvaptan) Isn't Approved by Blue Cross Blue Shield in Pennsylvania: Formulary Alternatives & Exception Paths

Answer Box: Your Options When Jynarque Is Denied If Blue Cross Blue Shield Pennsylvania denies Jynarque (tolvaptan) for ADPKD, you have three paths: request a step therapy exception with documented rapid progression (Mayo class 1C-1E), try formulary alternatives like supportive therapies while building your case, or file an appeal through

How to Get Photrexa (Riboflavin) Covered by Aetna CVS Health in Pennsylvania: Prior Authorization Guide

Quick Answer: Getting Photrexa Covered by Aetna CVS Health in Pennsylvania Aetna CVS Health requires prior authorization for Photrexa (riboflavin ophthalmic solution) used in FDA-approved corneal cross-linking for progressive keratoconus in Pennsylvania. Your fastest path to approval: (1) Gather documented progression evidence (serial topography showing Kmax increases, pachymetry showing thinning)

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

Answer Box: Getting Soliris (Eculizumab) Covered by Humana in Pennsylvania Yes, Humana covers Soliris (eculizumab) in Pennsylvania, but requires strict prior authorization. The medication typically falls under Tier 5 (specialty tier) with 25-33% coinsurance. Your fastest path to approval: 1) Ensure meningococcal vaccination is completed at least 2 weeks before

How to Get Dojolvi (Triheptanoin) Covered by UnitedHealthcare in Pennsylvania: Complete PA Guide & Appeal Scripts

Answer Box: Getting Dojolvi Covered by UnitedHealthcare in Pennsylvania Quick Path to Approval: UnitedHealthcare requires prior authorization for Dojolvi (triheptanoin) with molecular confirmation of long-chain fatty acid oxidation disorder (LCFAOD), prescription by a board-certified medical geneticist, and no concurrent MCT oil use. If denied, Pennsylvania's new external review

Myths vs. Facts: Getting Idelvion (Albutrepenonacog Alfa) Covered by Humana in Pennsylvania

Answer Box: Get Idelvion Covered by Humana in Pennsylvania Fastest path to approval: Submit prior authorization through Humana Provider Portal with factor IX deficiency documentation, bleeding history, and inhibitor status. If denied, appeal within 65 days—Pennsylvania's external review program has a 50% overturn rate. Start today: Contact

Myths vs. Facts: Getting Zolgensma Covered by Cigna in Pennsylvania (Complete Appeals Guide)

Answer Box: Getting Zolgensma Covered by Cigna in Pennsylvania Myth: If your doctor prescribes Zolgensma, Cigna automatically covers it. Fact: Prior authorization is mandatory, requiring genetic confirmation, anti-AAV9 antibody testing ≤1:50, and certified site-of-care documentation. In Pennsylvania, if denied, you have strong appeal rights—the state's external

How to Get Ultomiris (ravulizumab) Covered by UnitedHealthcare in Pennsylvania: Complete Guide to Prior Authorization, Appeals & Forms

Quick Answer: Getting Ultomiris Covered by UnitedHealthcare in Pennsylvania To get Ultomiris (ravulizumab) covered by UnitedHealthcare in Pennsylvania, you'll need prior authorization through OptumRx. The fastest path: 1) Have your doctor submit a PA request via the UnitedHealthcare provider portal with complete clinical documentation, 2) Include proof of

How to Get Duopa Covered by Blue Cross Blue Shield in Pennsylvania: Appeals Guide with Forms and Timelines

Answer Box: Getting Duopa Covered by Blue Cross Blue Shield in Pennsylvania Duopa requires prior authorization from all Pennsylvania Blue Cross Blue Shield plans in 2024. Success requires documenting advanced Parkinson's disease with motor fluctuations, failed oral therapy trials, and surgical candidacy for PEG-J placement. If denied, Pennsylvania&

How to Get Rapivab (Peramivir) Covered by Aetna CVS Health in Pennsylvania: Appeals Guide & Templates

Quick Answer: Getting Rapivab Covered by Aetna CVS Health in Pennsylvania Rapivab (peramivir) requires prior authorization from Aetna CVS Health and is covered on their 2024 Medicare formulary in Pennsylvania. If denied, you have strong appeal rights: complete Aetna's internal appeal within 180 days, then use Pennsylvania'

Complete Guide: Getting Imbruvica (ibrutinib) Covered by UnitedHealthcare in Pennsylvania - Prior Authorization, Appeals, and Success Strategies

Answer Box: Your Path to Imbruvica Coverage in Pennsylvania Getting Imbruvica (ibrutinib) covered by UnitedHealthcare in Pennsylvania requires prior authorization, proper diagnosis documentation, and often step therapy compliance. Most approvals take 5-15 business days with complete submissions. If denied, Pennsylvania's new external review program has overturned 50% of