Topic

Pennsylvania

A collection of 415 issues

How to Get Rezlidhia (olutasidenib) Covered by UnitedHealthcare in Pennsylvania: Prior Authorization, Appeals, and Renewal Guide

Answer Box: Getting Rezlidhia (olutasidenib) covered by UnitedHealthcare in Pennsylvania requires prior authorization with IDH1 mutation testing, documented AML diagnosis, and prior therapy history. If denied, you have 180 days for internal appeals, then 4 months for Pennsylvania's external review (50% overturn rate). Start by having your oncologist
6 min read

How to Get Dupixent (Dupilumab) Covered by Cigna in Pennsylvania: Complete Guide with Forms, Appeals, and Coding

Answer Box: Getting Dupixent Covered by Cigna in Pennsylvania Cigna requires prior authorization for Dupixent (dupilumab) with specific clinical criteria including diagnosis documentation, prior treatment failures, and prescriber specialty. If denied, Pennsylvania's new Independent External Review program has overturned about 50% of appealed denials. First step: Gather your
6 min read

How to Get Voxzogo (vosoritide) Covered by UnitedHealthcare in Pennsylvania: 2025 Requirements, Appeals, and Documentation

Answer Box: Quick Path to Voxzogo Coverage UnitedHealthcare requires prior authorization for Voxzogo (vosoritide) in Pennsylvania. Your fastest path to approval: (1) Ensure prescription comes from a pediatric endocrinologist or geneticist, (2) Submit complete PA with FGFR3 genetic test results, open growth plate imaging, and baseline growth data via UnitedHealthcare
6 min read

How to Get Stelara (Ustekinumab) Covered by Blue Cross Blue Shield in Pennsylvania: Forms, Appeals, and Success Strategies

Quick Answer: Getting Stelara Covered by Blue Cross Blue Shield in Pennsylvania Blue Cross Blue Shield Pennsylvania requires prior authorization for Stelara (ustekinumab), but approval is achievable with proper documentation. Submit the Medical Injectable Specialty Drug Prior Authorization Form through your provider, including diagnosis codes, prior treatment failures, and clinical
7 min read

Getting Symdeko/Symkevi (Tezacaftor/Ivacaftor) Covered by Cigna in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Coverage Symdeko/Symkevi (tezacaftor/ivacaftor) requires prior authorization from Cigna in Pennsylvania. Submit genetic testing showing F508del mutation, CF diagnosis, and specialist prescription via Cigna's provider portal. If denied, use internal appeals within 180 days, then Pennsylvania's Independent External Review (50%
6 min read

How to Get Nourianz (Istradefylline) Approved by Aetna CVS Health in Pennsylvania: Step-by-Step Prior Authorization Guide

Answer Box: Getting Nourianz (Istradefylline) Approved by Aetna CVS Health in Pennsylvania Aetna CVS Health requires prior authorization for Nourianz (istradefylline) with step therapy requirements in Pennsylvania. You'll need documented failure of amantadine, MAO-B inhibitors (like rasagiline), or COMT inhibitors (like entacapone), plus proof of 3+ hours daily
6 min read

The Requirements Checklist to Get Ocrevus (ocrelizumab) Covered by Aetna (CVS Health) in Pennsylvania: Forms, Appeals, and Approval Timeline

Answer Box: Getting Ocrevus Covered by Aetna in Pennsylvania Fastest path to approval: Submit Aetna's Ocrevus Medication Precertification Request form with neurologist documentation of MS diagnosis, prior therapy failures, and MRI evidence of disease activity. If denied, you can appeal internally within 180 days, then request Pennsylvania'
5 min read

How to Get Hetlioz LQ (Tasimelteon Oral Suspension) Covered by Humana in Pennsylvania: Prior Authorization Guide with Appeal Templates

Quick Answer: Hetlioz LQ (tasimelteon oral suspension) requires prior authorization for Humana plans in Pennsylvania. You'll need confirmed Smith-Magenis syndrome diagnosis with genetic testing, documented sleep disturbances, and evidence of failed alternatives. Submit via Humana's provider portal with complete documentation. If denied, Pennsylvania's new
6 min read