Topic

Pennsylvania

A collection of 244 issues

Getting Zolgensma (onasemnogene abeparvovec) Covered by Cigna in Pennsylvania: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Zolgensma Approved by Cigna in Pennsylvania Zolgensma requires prior authorization through Cigna's specialty pharmacy (Accredo) with strict eligibility criteria: genetic confirmation of SMA, patient under age 2, specialist prescription, and comprehensive clinical documentation. If denied, Pennsylvania's new external review process has a 53%

How to Get Jakafi (Ruxolitinib) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Guide to Prior Authorization and Appeals

Answer Box: Jakafi (ruxolitinib) requires prior authorization from all Blue Cross Blue Shield plans in Pennsylvania. Your doctor must document your diagnosis (myelofibrosis or polycythemia vera), prove hydroxyurea failure or intolerance, and submit clinical notes through your plan's PA portal. If denied, Pennsylvania's new external review

Complete Guide to Getting Prolastin-C Covered by Aetna in Pennsylvania: Prior Authorization, Appeals, and Success Strategies

Answer Box: Getting Prolastin-C Covered by Aetna in Pennsylvania Yes, Aetna requires prior authorization for Prolastin-C in Pennsylvania. Success requires documented alpha-1 antitrypsin deficiency (Pi*ZZ genotype), serum AAT levels <80 mg/dL, evidence of emphysema, and FEV1 between 25-80% of predicted. Fastest path to approval: 1. Gather genetic

How to Get iLink® Corneal Cross-Linking Covered by Aetna CVS Health in Pennsylvania: Prior Authorization Guide and Appeals Process

Quick Answer: Getting iLink® Covered by Aetna CVS Health in Pennsylvania Aetna CVS Health covers FDA-approved iLink® corneal cross-linking for progressive keratoconus in Pennsylvania when you meet specific criteria. Prior authorization is required with documented disease progression, minimum 400-micron corneal thickness, and use of an in-network provider. If denied, Pennsylvania&

How to Get Xywav (Ca/Mg/K/Na oxybates) Covered by Aetna (CVS Health) in Pennsylvania: Complete Guide to Prior Authorization, Appeals, and Cost Savings

Answer Box: Getting Xywav Covered by Aetna (CVS Health) in Pennsylvania Aetna requires prior authorization for Xywav with step therapy documentation (modafinil/armodafinil trials for adults, stimulants for all ages) and REMS enrollment. If denied, Pennsylvania's new external review program overturns 50% of appeals. First step today: Have

How to Get Imbruvica (Ibrutinib) Covered by Humana in Pennsylvania: Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Imbruvica Covered by Humana in Pennsylvania Yes, Humana covers Imbruvica (ibrutinib) for FDA-approved uses, but prior authorization is required. The fastest path: Have your oncologist submit a PA request through Humana's provider portal with your diagnosis, treatment history, and medical necessity letter. If denied, you

Getting Gattex (Teduglutide) Covered by Cigna in Pennsylvania: Forms, Appeals, and Cost-Saving Strategies

Answer Box: Fast Track to Approval Cigna requires prior authorization for Gattex (teduglutide) in Pennsylvania. Your gastroenterologist must document short bowel syndrome with parenteral nutrition dependency, failed enteral strategies, and ongoing monitoring. If denied, Pennsylvania's external review program has a 50% overturn rate. First step today: Have your

Do You Qualify for Mepsevii Coverage by UnitedHealthcare in Pennsylvania? Complete Decision Tree & Appeals Guide

Answer Box: Getting Mepsevii Covered by UnitedHealthcare in Pennsylvania Yes, you can get Mepsevii (vestronidase alfa-vjbk) covered by UnitedHealthcare in Pennsylvania if you have confirmed MPS VII diagnosis. UnitedHealthcare requires prior authorization but does NOT require step therapy since Mepsevii is the only FDA-approved treatment for MPS VII. First step

Cigna's Coverage Criteria for Xospata (Gilteritinib) in Pennsylvania: What Counts as "Medically Necessary"?

Answer Box: Getting Xospata Covered by Cigna in Pennsylvania Cigna requires prior authorization for Xospata (gilteritinib) in Pennsylvania. To qualify, you need: (1) confirmed relapsed/refractory AML with FLT3 mutation via FDA-approved test, (2) documented failure of prior AML therapy, and (3) prescription from a hematologist/oncologist. First step today:

Myths vs. Facts: Getting Evrysdi (Risdiplam) Covered by UnitedHealthcare in Pennsylvania - Appeals Guide 2025

Answer Box: Getting Evrysdi Covered by UnitedHealthcare in Pennsylvania Eligibility: UnitedHealthcare requires prior authorization for Evrysdi with genetic confirmation of SMA, SMN2 copy documentation (2-4 copies for symptomatic patients), and baseline motor function assessments. No step therapy required, but concurrent use with Spinraza is prohibited. Fastest Path: Submit complete PA