Topic

Pennsylvania

A collection of 498 issues

How to Get Elfabrio (Pegunigalsidase Alfa) Covered by Cigna in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Elfabrio Covered by Cigna in Pennsylvania Cigna requires prior authorization for Elfabrio (pegunigalsidase alfa-iwxj) in Pennsylvania through Express Scripts/Accredo specialty pharmacy. Submit the Elfabrio CCRD PA form with confirmed Fabry disease diagnosis (deficient α-galactosidase A enzyme <4% normal OR pathogenic GLA gene variant), age 18+
6 min read

How to Get Luxturna (Voretigene Neparvovec-rzyl) Covered by Humana in Pennsylvania: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Luxturna Covered by Humana in Pennsylvania Humana Medicare plans require prior authorization for Luxturna (voretigene neparvovec-rzyl) with specific genetic testing and facility requirements. Key steps: (1) Confirm biallelic RPE65 mutations via authorized lab testing, (2) Schedule evaluation at UPMC Eye Center or CHOP, and (3) Submit prior
5 min read

How to Get Vigabatrin Covered by Blue Cross Blue Shield in Pennsylvania: Complete 2025 Prior Authorization Guide

Answer Box: Getting Vigabatrin Covered in Pennsylvania Blue Cross Blue Shield Pennsylvania requires prior authorization for vigabatrin (generic) and Sabril with mandatory REMS enrollment and vision monitoring. The fastest path: (1) Enroll in Vigabatrin REMS (prescriber, patient, pharmacy), (2) Complete baseline ophthalmology exam, (3) Submit PA with diagnosis, failed prior
5 min read

Myths vs. Facts: Getting Helixate (Antihemophilic Factor rFVIII) Covered by UnitedHealthcare in Pennsylvania

Quick Answer: Helixate Coverage by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Helixate (antihemophilic factor rFVIII) in Pennsylvania, but coverage is available for confirmed hemophilia A patients. Submit requests via the UHC Provider Portal or call OptumRx at 866-889-8054 with diagnosis documentation (ICD-10 D66), factor VIII levels, and bleeding
5 min read

How Long Does It Take to Get Cabometyx (Cabozantinib) Approved by Aetna CVS Health in Pennsylvania? Complete Timeline Guide

Answer Box: Cabometyx (Cabozantinib) Approval Timeline for Aetna CVS Health in Pennsylvania Cabometyx requires a formulary exception from Aetna CVS Health (excluded from Advanced Control formulary), taking 30-45 days for standard review or 72 hours for expedited cases. Pennsylvania residents benefit from a state external review program with 53% success
6 min read

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

Answer Box: Fast Track to Revcovi Coverage in Pennsylvania Aetna (CVS Health) requires prior authorization for Revcovi (elapegademase) in Pennsylvania. Your fastest path: 1) Confirm ADA-SCID diagnosis with enzyme/genetic testing, 2) Have your immunologist/hematologist submit PA through Aetna's provider portal with medical necessity letter citing FDA
6 min read

How to Get Kesimpta (Ofatumumab) Covered by UnitedHealthcare in Pennsylvania: Prior Authorization, Appeals, and Cost-Saving Strategies

Quick Answer: Getting Kesimpta Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Kesimpta (ofatumumab) through OptumRx, typically mandating step therapy with other disease-modifying therapies first. Your neurologist submits the PA via UHC Provider Portal with MS diagnosis (ICD-10 G35), prior DMT failures, and baseline labs. Standard decisions take
6 min read