Topic

Pennsylvania

A collection of 499 issues

If Elfabrio Isn't Approved by Humana in Pennsylvania: Formulary Alternatives & Exception Paths

Answer Box: Your Options When Humana Denies Elfabrio in Pennsylvania Elfabrio (pegunigalsidase alfa) isn't on Humana's standard formulary, but you have three paths: request a formulary exception for Elfabrio coverage, try Fabrazyme (the preferred alternative), or appeal through Pennsylvania's external review if commercial coverage.

How to Get Pemazyre (pemigatinib) Covered by Aetna (CVS Health) in Pennsylvania: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Pemazyre Covered in Pennsylvania Pemazyre (pemigatinib) requires prior authorization from Aetna CVS Health for FGFR2 fusion-positive cholangiocarcinoma. In Pennsylvania, you have strong appeal rights including a new state external review program with 50%+ overturn rates. First step today: Have your oncologist submit PA via Aetna's

How to Get Pyrukynd (mitapivat) Covered by Aetna CVS Health in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Your Fastest Path to Pyrukynd Coverage Getting Pyrukynd (mitapivat) covered by Aetna CVS Health in Pennsylvania requires prior authorization through CVS Caremark. Most approvals happen within 24-72 hours when clinical criteria are met. First step today: Have your hematologist gather genetic confirmation of pyruvate kinase deficiency, baseline labs

How to Get Ibrance (Palbociclib) Covered by UnitedHealthcare in Pennsylvania: Complete Decision Tree & Appeals Guide

Quick Answer: Are You Eligible for Ibrance Coverage? UnitedHealthcare requires prior authorization for Ibrance (palbociclib) in Pennsylvania for HR+/HER2- advanced breast cancer when combined with aromatase inhibitors or fulvestrant. You'll need pathology confirming hormone receptor status, disease staging, and oncologist documentation. If denied, Pennsylvania's new

How to Get Gilenya (fingolimod) Covered by UnitedHealthcare in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Gilenya (fingolimod) Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Gilenya (fingolimod) with documented step therapy failures and safety monitoring. The fastest path: gather baseline EKG, eye exam, and vaccination records, document 2+ prior MS therapy failures, and submit via OptumRx portal. If denied, Pennsylvania&

Myths vs. Facts: Getting Tecentriq (atezolizumab) Covered by Aetna (CVS Health) in Pennsylvania

Answer Box: Tecentriq (atezolizumab) requires prior authorization from Aetna (CVS Health) in Pennsylvania, with approval based on FDA-indicated use, PD-L1 testing results (≥1% for adjuvant NSCLC, ≥50% for first-line metastatic), and documentation of failed alternatives where required. If denied after internal appeal, Pennsylvania's Independent External Review program offers

How to Get Cerezyme (Imiglucerase) Covered by Humana in Pennsylvania: Complete Coverage Guide

Answer Box: Your Path to Coverage Humana classifies Cerezyme (imiglucerase) as a nonpreferred drug requiring prior authorization and step therapy to preferred agents (Elelyso or Vpriv) first. To get coverage in Pennsylvania: (1) Submit PA request with Type 1 Gaucher disease diagnosis and step therapy documentation, (2) If denied, file

How to Get Upstaza (Eladocagene Exuparvovec) Covered by Cigna in Pennsylvania: Complete Forms, Appeals, and Contact Guide

Answer Box: Getting Upstaza Covered by Cigna in Pennsylvania Cigna requires prior authorization for Upstaza (eladocagene exuparvovec) through Express Scripts/Accredo, with specific criteria including genetic confirmation of AADC deficiency and failed standard therapies. Submit via CoverMyMeds portal or call 800-753-2851 with genetic testing, severity assessment, and certified neurosurgical center

Renewing Prolastin-C Coverage with Cigna in Pennsylvania: Complete 2025 Guide to Authorization, Appeals, and Timing

Answer Box: Fastest Path to Prolastin-C Renewal Cigna requires annual reauthorization for Prolastin-C in Pennsylvania. Start your renewal 60-90 days before expiration by gathering updated spirometry (within 6 months), recent clinical notes from your pulmonologist, and documentation of continued clinical benefit. Submit via your provider's Cigna portal or

How to Get Onivyde (Irinotecan Liposome) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Appeal Guide with Forms and Timelines

Quick Answer: Getting Onivyde Covered by Blue Cross Blue Shield in Pennsylvania Blue Cross Blue Shield plans in Pennsylvania require prior authorization for Onivyde (irinotecan liposome) as a specialty cancer treatment. Submit PA requests through your plan's provider portal with pathology-confirmed metastatic pancreatic adenocarcinoma, ECOG performance status 0-1,