Topic

Pennsylvania

A collection of 499 issues

Work With Your Doctor to Get Opzelura (Ruxolitinib Cream) Covered by Blue Cross Blue Shield in Pennsylvania

Answer Box: Getting Opzelura Covered in Pennsylvania Blue Cross Blue Shield requires prior authorization for Opzelura (ruxolitinib cream) with documentation of failed topical steroids and calcineurin inhibitors. Your dermatologist must submit clinical notes showing inadequate response to first-line treatments. If denied, Pennsylvania's new external review program overturns about
7 min read

Renewing Uptravi (Selexipag) Coverage with Cigna in Pennsylvania: Timeline, Documentation & Appeal Rights

Answer Box: Uptravi (Selexipag) Renewal Process Renewal Timeline: Cigna approves Uptravi for 1-year periods. Start renewal 60-90 days before expiration to avoid gaps. Required Documentation: WHO Group I PAH confirmation, 6-minute walk test results, functional class assessment, and tolerability records. Submit Through: Cigna provider portal at covermymeds.com or precertification
5 min read

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

Answer Box: Getting Tegsedi Covered by UnitedHealthcare in Pennsylvania Fastest Path: Complete FDA REMS enrollment (both patient and prescriber) → Submit prior authorization through UHC Provider Portal with genetic testing, baseline labs, and neurologist consultation → If denied, file internal appeal within 180 days → Use Pennsylvania's External Review Program (50%
6 min read

How to Get Orladeyo (berotralstat) Covered by UnitedHealthcare in Pennsylvania: Complete Guide to Prior Authorization, Appeals, and State Protections

Quick Answer: Getting Orladeyo Covered in Pennsylvania Fast track to approval: Submit prior authorization through UnitedHealthcare's provider portal with complete HAE diagnosis documentation, C1-INH lab results, and evidence of failed/contraindicated injectable therapies. If denied, you have 180 days for internal appeals, then 4 months for Pennsylvania'
6 min read

Lowering Out-of-Pocket Costs for Fintepla with UnitedHealthcare in Pennsylvania: Complete Copay, Tiering & Financial Assistance Guide

Answer Box: Getting Fintepla Covered by UnitedHealthcare in Pennsylvania Fintepla (fenfluramine) requires prior authorization from UnitedHealthcare and is placed on Specialty Tier 5 with high out-of-pocket costs. To minimize expenses: 1) Apply for UCB's ONWARD Copay Assistance Program (can reduce copays to $0-$25 for commercial insurance), 2)
5 min read

How to Get Keytruda (Pembrolizumab) Approved by UnitedHealthcare in Pennsylvania: Complete Timeline and Appeals Guide

Quick Answer: Getting Keytruda Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Keytruda (pembrolizumab) in Pennsylvania, typically taking 5-14 business days for standard review. You'll need biomarker testing (PD-L1, MSI-H, or TMB-H), complete staging documentation, and evidence of medical necessity aligned with NCCN guidelines. If denied,
5 min read

How to Get Dupixent (dupilumab) Covered by UnitedHealthcare in Pennsylvania: Prior Authorization, Appeals, and Alternative Options

Answer Box: Getting Dupixent Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Dupixent (dupilumab) in Pennsylvania, with a 72-hour review timeline. Most approvals require documented diagnosis, prior therapy failures, and specialist prescription. If denied, you have 180 days for internal appeals, then 4 months for Pennsylvania's
5 min read