Topic

Pennsylvania

A collection of 499 issues

How to Get Filspari (sparsentan) Covered by Blue Cross Blue Shield in Pennsylvania: Prior Authorization Guide and Appeals Process

Quick Answer: Getting Filspari Covered by Blue Cross Blue Shield in Pennsylvania Filspari (sparsentan) requires prior authorization from Blue Cross Blue Shield plans in Pennsylvania. You'll need: confirmed IgA nephropathy diagnosis via kidney biopsy, documented REMS enrollment, quarterly liver function tests, and evidence of failed ACE inhibitor/ARB
6 min read

Get Firazyr (icatibant injection) Covered by Cigna in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Firazyr Covered by Cigna in Pennsylvania Firazyr (icatibant injection) requires prior authorization from Cigna for hereditary angioedema (HAE) treatment. Fastest path to approval: Have your HAE specialist submit a complete PA request with confirmed HAE diagnosis (low C1-INH levels), documented attack history, and specialist consultation notes. Cigna
5 min read

Getting Gamifant (Emapalumab) Covered by Humana in Pennsylvania: Complete Guide with Forms and Appeals Process

Quick Answer: Getting Gamifant Covered by Humana in Pennsylvania Yes, Humana covers Gamifant (emapalumab-lzsg) with prior authorization for primary HLH. The fastest path: Your hematologist submits a PA request via fax (502-508-9300) with HLH-2004 diagnostic criteria, conventional therapy failure documentation, and infection screening results. Standard approval takes 7-30 days; expedited
6 min read

Do You Qualify for Revcovi (Elapegademase) Coverage by Humana in Pennsylvania? Complete Decision Tree & Appeals Guide

Quick Answer: Revcovi Coverage by Humana in Pennsylvania Eligibility: You likely qualify if you have confirmed ADA-SCID with biochemical or genetic testing showing adenosine deaminase deficiency below 1% of normal. Fastest path: Have your immunologist submit prior authorization with ADA enzyme activity results, genetic testing, and medical necessity letter through
6 min read

How to Get Helixate (Antihemophilic Factor rFVIII) Covered by Cigna in Pennsylvania: Complete Coding and Appeals Guide

Answer Box: Getting Helixate Covered by Cigna in Pennsylvania Helixate (antihemophilic factor rFVIII) requires prior authorization from Cigna, with documentation of hemophilia A diagnosis (ICD-10: D66), recent Factor VIII inhibitor testing, and medical necessity from a hemophilia specialist. Fastest path: Submit PA through Cigna's provider portal with complete
5 min read

How Long Does It Take to Get Oxervate (Cenegermin) Approved by UnitedHealthcare in Pennsylvania? Complete Timeline & Appeals Guide

Answer Box: Getting Oxervate Approved by UnitedHealthcare in Pennsylvania Timeline: UnitedHealthcare typically decides prior authorization requests within 5-14 business days, though OptumRx's automated system can approve qualifying requests in under 30 seconds. Key requirements: Stage 2 or 3 neurotrophic keratitis diagnosis, documented failure of at least one OTC
5 min read