Topic

Pennsylvania

A collection of 499 issues

Getting Pombiliti (Cipaglucosidase Alfa-atga) Covered by Humana in Pennsylvania: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Fastest Path to Coverage Pombiliti requires prior authorization from Humana and is typically covered as a Part D specialty drug through CenterWell Specialty Pharmacy. Your prescriber must submit a PA request with documented late-onset Pompe disease diagnosis, prior ERT response, and clinical justification. If denied, you have 60-65
7 min read

How to Get Pomalyst (pomalidomide) Covered by Humana in Pennsylvania: Complete PA Guide, Forms & Appeals

Answer Box: Getting Pomalyst Covered by Humana in Pennsylvania For Pennsylvania residents with Humana Medicare Advantage or Part D: Pomalyst (pomalidomide) typically requires prior authorization. Submit Humana's "Request for Medicare Prescription Drug Coverage Determination" form with clinical documentation showing prior lenalidomide/proteasome inhibitor failure. First step
5 min read

How to Get Aldurazyme (laronidase) Covered by Aetna (CVS Health) in Pennsylvania: Prior Authorization, Appeals, and Cost Assistance Guide

Answer Box: Getting Aldurazyme (laronidase) Covered by Aetna (CVS Health) in Pennsylvania Fastest path to approval: Submit prior authorization through CVS Specialty Pharmacy with genetic confirmation of MPS I, enzyme assay results, and specialist attestation. If denied, you have 180 days for internal appeals, then 4 months for Pennsylvania'
5 min read

Renewing Hemgenix (etranacogene dezaparvovec) Approval with Blue Cross Blue Shield in Pennsylvania: Annual Requirements and Timeline

Answer Box: Renewing Hemgenix Coverage in Pennsylvania Hemgenix (etranacogene dezaparvovec) is a one-time gene therapy, but Blue Cross Blue Shield plans in Pennsylvania may require annual clinical documentation for outcomes monitoring and related services coverage. Start renewal submissions 60-90 days before your authorization period expires. Submit updated Factor IX levels,
7 min read

How to Get Trikafta Covered by Aetna CVS Health in Pennsylvania: Complete Prior Authorization and Appeals Guide 2025

Answer Box: Getting Trikafta Covered by Aetna CVS Health in Pennsylvania Trikafta requires prior authorization from Aetna CVS Health with specific documentation: CF diagnosis, CFTR genotype (F508del or responsive mutation), age ≥2 years, and specialist prescription. Submit via CVS Specialty at 1-800-237-2767 with required labs and clinical notes. Standard approval
7 min read

How to Get HyperHEP (Hepatitis B Immune Globulin) Covered by UnitedHealthcare in Pennsylvania: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting HyperHEP Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare typically requires prior authorization for HyperHEP (hepatitis B immune globulin) with strict timing windows for post-exposure prophylaxis. First step: Check your formulary tier and PA requirements through the UnitedHealthcare provider portal or call 1-800-711-4555. For denials, Pennsylvania offers a robust
6 min read

Renewing Filsuvez (Birch Triterpenes Topical Gel) Approval with Cigna in Pennsylvania: Complete Timeline and Documentation Guide

Answer Box: Filsuvez Renewal with Cigna in Pennsylvania Cigna typically requires Filsuvez (birch triterpenes topical gel) prior authorization renewal every 6-12 months for epidermolysis bullosa patients. Start your renewal process 6-8 weeks before your current authorization expires to avoid treatment gaps. You'll need updated wound assessments, response documentation,
5 min read

How to Get Takhzyro (lanadelumab-flyo) Covered by Humana in Pennsylvania: Appeals Guide, Forms & Success Strategies

Answer Box: Getting Takhzyro Covered by Humana in Pennsylvania Yes, Humana Medicare Advantage requires prior authorization for Takhzyro (lanadelumab-flyo) in Pennsylvania. The fastest path to approval: 1) Confirm your HAE diagnosis with documented C1-INH lab abnormalities and attack frequency ≥1 per month, 2) Have your allergist/immunologist submit a complete
6 min read

Work With Your Doctor to Get Xospata (Gilteritinib) Covered by Blue Cross Blue Shield in Pennsylvania: Forms, Appeals, and Success Scripts

Answer Box: Getting Xospata Covered by Blue Cross Blue Shield in Pennsylvania Blue Cross Blue Shield plans in Pennsylvania require prior authorization for Xospata (gilteritinib), which is approved for adults with relapsed/refractory FLT3-mutated AML. Success requires: (1) documented FLT3 mutation test results, (2) evidence of prior therapy failure, and
6 min read