Topic

Pennsylvania

A collection of 499 issues

Myths vs. Facts: Getting Cabometyx (Cabozantinib) Covered by Cigna in Pennsylvania

Answer Box: To get Cabometyx covered by Cigna in Pennsylvania, you need prior authorization based on specific FDA-approved cancer indications (RCC, HCC, or DTC). Submit documentation showing diagnosis, prior therapy failures, and imaging evidence through your oncologist. If denied, Pennsylvania's new external review program has overturned ~50% of

How to Get Zolgensma (onasemnogene abeparvovec) Covered by Aetna (CVS Health) in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by Aetna in Pennsylvania Aetna covers Zolgensma (onasemnogene abeparvovec) for spinal muscular atrophy under strict prior authorization requiring: confirmed bi-allelic SMN1 mutations, age under 24 months, anti-AAV9 antibody titer ≤1:50, and treatment at an approved gene therapy center. If denied, you have 180 days

How to Renew Crysvita (Burosumab) Coverage with Blue Cross Blue Shield in Pennsylvania: Complete Timeline and Documentation Guide

Answer Box: Renewing Your Crysvita Coverage in Pennsylvania Blue Cross Blue Shield plans in Pennsylvania typically require annual reauthorization for Crysvita (burosumab) with documented clinical benefit and safety monitoring. Start your renewal 60-90 days before expiration to avoid gaps. Required documentation includes recent fasting serum phosphorus levels, alkaline phosphatase results,

How to Get Strensiq (asfotase alfa) Covered by UnitedHealthcare in Pennsylvania: Complete PA Forms, Appeals Timeline & Success Scripts

Answer Box: Getting Strensiq Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Strensiq (asfotase alfa) with strict pediatric-onset hypophosphatasia criteria. Fastest path: Submit PA through OptumRx with documented onset before age 18, genetic/biochemical confirmation, and specialist attestation. If denied, use Pennsylvania's external review program within

Myths vs. Facts: Getting Ilaris (Canakinumab) Covered by Cigna in Pennsylvania

Quick Answer: Cigna requires prior authorization for Ilaris (canakinumab) in Pennsylvania with specific criteria including specialist prescription, elevated CRP levels, and documented failure of standard therapies. If denied, you have 180 days for internal appeals, then 4 months for Pennsylvania's external review program, which overturns 50% of denials.

How to Get Myozyme (Alglucosidase Alfa) Covered by Humana in Pennsylvania: Timeline, Appeals, and Success Strategies

Answer Box: Getting Myozyme Covered by Humana in Pennsylvania Fastest path to approval: Submit a complete prior authorization with confirmed Pompe disease diagnosis (GAA enzyme testing + genetic confirmation), specialist prescriber documentation, and baseline clinical assessments. Humana typically decides within 14 days for standard requests, 72 hours for expedited cases. If

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

Quick Answer: Getting Joenja (leniolisib) Covered by Aetna CVS Health in Pennsylvania Fastest path to approval: Submit prior authorization with confirmed APDS genetic testing (pathogenic PIK3CD or PIK3R1 variant), specialist documentation, and prior therapy history. If denied, file internal appeal within 180 days, then pursue Pennsylvania's external review

How to Get Keppra (Levetiracetam) Covered by Humana in Pennsylvania: Appeals, Alternatives & Exception Forms

Answer Box: Getting Keppra (Levetiracetam) Covered by Humana in Pennsylvania Fastest path to approval: Check if generic levetiracetam is covered first—it's usually on a low tier without prior authorization. If you need brand Keppra specifically, your prescriber must submit a Medicare Part D coverage determination with medical

Work With Your Doctor to Get Opfolda (miglustat) Approved by Blue Cross Blue Shield in Pennsylvania: Complete Provider Partnership Guide

Answer Box: Getting Started Today To get Opfolda (miglustat) covered by Blue Cross Blue Shield in Pennsylvania, you'll need your doctor to submit a prior authorization showing you have late-onset Pompe disease (LOPD), weigh at least 40 kg, and haven't improved on standard enzyme replacement therapy.

Coding That Helps Get Procysbi (Cysteamine Bitartrate DR) Approved in Pennsylvania with Blue Cross Blue Shield (ICD-10, HCPCS/J-Code, NDC)

Answer Box: Getting Procysbi Covered in Pennsylvania Fast track to approval: Submit prior authorization with ICD-10 code E72.04 (nephropathic cystinosis), NDC 75987-100-04, complete WBC cystine monitoring data, and genetic testing results. Blue Cross Blue Shield Pennsylvania typically decides within 3 business days. If denied, you have 180 days to