Topic

Pennsylvania

A collection of 499 issues

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

How to Get Signifor LAR (Pasireotide) Approved by UnitedHealthcare in Pennsylvania: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Signifor LAR Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Signifor LAR (pasireotide) through OptumRx specialty pharmacy. Key requirements: endocrinologist prescription, documented Cushing's disease diagnosis with failed/contraindicated surgery, or acromegaly with failed first-generation somatostatin analogs. Submit complete clinical documentation including labs (24-hour

Myths vs. Facts: Getting Eloctate Covered by Cigna in Pennsylvania (Appeals Guide & Documentation)

Answer Box: Get Eloctate Covered by Cigna in Pennsylvania Eloctate requires prior authorization from Cigna, even with a hematologist's prescription. The fastest path to approval: (1) Ensure your hematologist submits complete PA documentation including hemophilia A diagnosis, inhibitor status, and bleeding history through Cigna's provider portal

How to Get Cresemba (Isavuconazole) Covered by UnitedHealthcare in Pennsylvania: Appeals, Alternatives & Success Strategies

Answer Box: Getting Cresemba Covered by UnitedHealthcare in Pennsylvania Cresemba (isavuconazole) requires prior authorization from UnitedHealthcare and is typically Tier 3 with step therapy requirements. Your fastest path: 1) Try required alternatives (usually voriconazole, posaconazole, or fluconazole) first or document contraindications/failures, 2) Submit PA through OptumRx with infectious disease

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

Answer Box: Get Takhzyro Covered by Aetna CVS Health in Pennsylvania To get Takhzyro (lanadelumab) covered by Aetna CVS Health in Pennsylvania, you need prior authorization with confirmed HAE diagnosis, specialist prescriber (allergist/immunologist), and documented failure of alternatives like Haegarda or Orladeyo. Submit your PA request via Aetna'

How to Get Tavalisse Covered by UnitedHealthcare in Pennsylvania: Complete PA Guide with Forms and Appeal Scripts

Answer Box: Getting Tavalisse Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization and step therapy for Tavalisse (fostamatinib) in Pennsylvania. You need a hematologist to prescribe it, documented failure of corticosteroids and a TPO receptor agonist, and platelet counts typically below 30,000/μL. Submit via the UHC Provider