Topic

Pennsylvania

A collection of 499 issues

Oxbryta (Voxelotor) Coverage by UnitedHealthcare in Pennsylvania: 2024 FDA Withdrawal Impact and Alternative Treatments

Answer Box: Oxbryta Coverage Status Oxbryta (voxelotor) was withdrawn from the U.S. market on September 25, 2024, following FDA safety concerns. UnitedHealthcare and all insurers now universally deny coverage—no appeals process exists for a withdrawn drug. If you were taking Oxbryta, contact your sickle cell specialist immediately to

How to Get Tracleer (bosentan) Covered by Aetna CVS Health in Pennsylvania: Complete Prior Authorization Guide

Answer Box: Getting Tracleer (bosentan) Covered by Aetna CVS Health in Pennsylvania Tracleer (bosentan) is typically non-formulary on Aetna's 2025 commercial plans, requiring prior authorization and step therapy with preferred alternatives like ambrisentan or Opsumit. All patients must enroll in the mandatory REMS program before dispensing. In Pennsylvania,

Get Evkeeza (Evinacumab) Covered by UnitedHealthcare in Pennsylvania: Step-by-Step Approval Guide

Quick Answer: Getting Evkeeza Covered in Pennsylvania To get Evkeeza (evinacumab) approved by UnitedHealthcare in Pennsylvania, you need: confirmed HoFH diagnosis with LDL-C >400 mg/dL, documented failures of maximum-tolerated statins/ezetimibe/PCSK9 inhibitors, and prior authorization through the UnitedHealthcare Provider Portal. If denied, Pennsylvania's new external

How to Get Strimvelis Gene Therapy Covered by Aetna in Pennsylvania: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Strimvelis Covered by Aetna in Pennsylvania Strimvelis gene therapy for ADA-SCID requires extensive prior authorization from Aetna, including genetic confirmation, enzyme testing, and proof of no suitable bone marrow donor. Since treatment is only available in Milan, Italy, you'll need international coverage approval. Start with

How to Get Nucala (Mepolizumab) Covered by Blue Cross Blue Shield in Pennsylvania: 2024 Appeals Guide

Answer Box: Getting Nucala Covered in Pennsylvania To get Nucala (mepolizumab) covered by Blue Cross Blue Shield in Pennsylvania: Your doctor must submit a prior authorization request with blood eosinophil count ≥150 cells/µL, proof of severe eosinophilic asthma uncontrolled on high-dose ICS/LABA therapy, and exacerbation history. If denied,

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