Topic

Pennsylvania

A collection of 499 issues

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

How to Get Cosentyx (secukinumab) Covered by UnitedHealthcare in Pennsylvania: Complete PA Guide with Appeals Process

Answer Box: Getting Cosentyx Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Cosentyx (secukinumab) with step therapy through preferred biologics first. Submit PA via the UHCprovider.com portal with diagnosis documentation, prior treatment failures, and clinical response data. If denied, Pennsylvania's new external review program overturns
6 min read

Work With Your Doctor to Get Upstaza (Kebilidi) Covered by Aetna in Pennsylvania: Complete Provider Partnership Guide

Answer Box: Getting Aetna to Cover Upstaza (Kebilidi) in Pennsylvania Upstaza (Kebilidi) requires prior authorization from Aetna with genetic confirmation of AADC deficiency, treatment at a designated center, and comprehensive medical documentation. Your doctor must submit genetic testing results, enzyme assays, and clinical notes showing failed standard therapies. If denied,
6 min read

How to Get Uplizna (Inebilizumab) Covered by Cigna in Pennsylvania: Complete Guide to Prior Authorization, Appeals, and Cost Savings

Answer Box: Getting Uplizna Covered by Cigna in Pennsylvania Uplizna (inebilizumab) requires prior authorization from Cigna and is typically covered on Tier 5 (specialty) with mandatory use of Accredo specialty pharmacy. The fastest path to approval: 1) Have your neurologist submit a comprehensive PA request documenting AQP4-positive NMOSD diagnosis and
6 min read

Getting Therakos CELLEX Photopheresis Covered by Cigna in Pennsylvania: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Therakos CELLEX Covered by Cigna in Pennsylvania Yes, Cigna covers Therakos CELLEX photopheresis for FDA-approved indications like cutaneous T-cell lymphoma (CTCL) and steroid-refractory graft-versus-host disease (GVHD), but prior authorization is required. Submit your PA through Cigna's provider portal with detailed documentation of failed prior therapies
6 min read