Topic

Pennsylvania

A collection of 499 issues

How to Get Hemgenix (Etranacogene Dezaparvovec) Covered by Cigna in Pennsylvania: Complete Appeals Guide and Timeline

Answer Box: Getting Hemgenix Covered by Cigna in Pennsylvania Hemgenix (etranacogene dezaparvovec) requires prior authorization from Cigna with strict clinical criteria. You must have hemophilia B, be on Factor IX prophylaxis or have serious bleeding history, test negative for inhibitors, and have no prior gene therapy. If denied, Pennsylvania'

Getting Aldurazyme (Laronidase) Covered by Humana in Pennsylvania: Complete Prior Authorization Guide

Answer Box: Quick Start Guide Aldurazyme (laronidase) is covered by Humana Medicare Advantage plans in Pennsylvania as a Part B medical benefit, but requires prior authorization. The fastest path to approval: (1) Ensure your specialist submits PA with genetic/enzymatic MPS I confirmation, (2) Include detailed infusion monitoring plan and

How to Get Myalept (Metreleptin) Covered by Humana in Pennsylvania: Complete Requirements Checklist with Forms and Appeals

Quick Answer: Getting Myalept Covered by Humana in Pennsylvania Myalept (metreleptin) requires prior authorization from Humana and REMS program enrollment. For Pennsylvania members, follow these three steps: 1) Ensure your doctor completes Humana's pharmacy prior authorization form with confirmed generalized lipodystrophy diagnosis (ICD-10: E88.12), 2) Enroll in

How to Get Increlex (mecasermin) Covered by Aetna CVS Health in Pennsylvania: Forms, Appeals & Resources

Answer Box: Getting Increlex (mecasermin) Covered by Aetna CVS Health in Pennsylvania Quick Path to Approval: Aetna requires prior authorization for Increlex (mecasermin) through CVS Specialty Pharmacy. Your endocrinologist must submit documentation proving severe primary IGF-1 deficiency with height ≥3 SD below normal and normal/elevated growth hormone levels. Start

Get Cometriq (Cabozantinib) Covered by UnitedHealthcare in Pennsylvania: Complete Forms, Appeals & Contact Guide

Answer Box: Getting Cometriq Covered by UnitedHealthcare in Pennsylvania Fastest path to approval: Submit prior authorization through the UnitedHealthcare Provider Portal with oncologist documentation of progressive, metastatic medullary thyroid cancer. Required: ICD-10 diagnosis codes, pathology reports, and evidence of disease progression. Timeline: 72 hours for standard PA decisions. If denied:

Getting Kanuma (Sebelipase Alfa) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Cost-Saving Guide

Answer Box: Getting Kanuma Covered in Pennsylvania Kanuma (sebelipase alfa) is typically covered by Blue Cross Blue Shield plans in Pennsylvania as a specialty drug requiring prior authorization. To get coverage: 1. Submit PA request with LAL-D diagnosis confirmation (enzyme activity test + LIPA genetic testing) 2. Use specialty pharmacy (required

Work With Your Doctor to Get HyperHEP (Hepatitis B Immune Globulin) Approved by Blue Cross Blue Shield in Pennsylvania

Answer Box: Getting HyperHEP Covered by Blue Cross Blue Shield in Pennsylvania Blue Cross Blue Shield Pennsylvania (Highmark and Independence) requires prior authorization for HyperHEP (hepatitis B immune globulin). Your fastest path to approval: work with your doctor to submit a complete prior authorization request documenting post-exposure prophylaxis need within

How Long Does It Take to Get Cresemba (Isavuconazole) Approved by Blue Cross Blue Shield in Pennsylvania? Complete Timeline & Appeals Guide

Answer Box: Quick Start Guide Getting Cresemba (isavuconazole) approved by Blue Cross Blue Shield in Pennsylvania typically takes 5-15 business days for standard prior authorization, or 72 hours for expedited urgent requests. Your fastest path: Have your infectious disease specialist submit a complete prior authorization through the BCBS provider portal

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

Quick Answer: Getting Pomalyst Covered by Aetna CVS Health in Pennsylvania Pomalyst (pomalidomide) requires prior authorization from Aetna CVS Health in Pennsylvania. Your fastest path to approval: (1) Ensure REMS program enrollment is complete, (2) Submit PA request with documented lenalidomide and proteasome inhibitor failure, and (3) Include oncologist attestation.

The Requirements Checklist to Get Signifor LAR (Pasireotide) Covered by Blue Cross Blue Shield in Pennsylvania: Forms, Appeals, and Success Strategies

Answer Box: Getting Signifor LAR Covered by BCBS in Pennsylvania Signifor LAR (pasireotide) requires prior authorization from all Blue Cross Blue Shield plans in Pennsylvania. The fastest path to approval: (1) Verify your plan's specialty pharmacy network and current PA form, (2) Submit complete documentation including failed first-line