Topic

Pennsylvania

A collection of 499 issues

The Complete Guide to Getting Cometriq (Cabozantinib) Covered by Humana in Pennsylvania: Forms, Appeals, and Success Strategies

Answer Box: Getting Cometriq Covered by Humana in Pennsylvania Cometriq (cabozantinib) requires prior authorization from Humana Medicare Advantage plans for medullary thyroid cancer treatment in Pennsylvania. Your fastest path to approval: 1) Have your oncologist submit a complete prior authorization request with diagnosis code C73 (thyroid cancer), prior treatment history,

How to Get Onpattro (patisiran) Covered by UnitedHealthcare in Pennsylvania: Complete PA Guide with Appeal Scripts

Answer Box: Getting Onpattro Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Onpattro (patisiran) but does NOT require step therapy with other hATTR treatments first. Key requirements: genetic confirmation of pathogenic TTR mutation, neurologist evaluation, disease staging (mNIS+7 or equivalent), and no concurrent RNA interference agents. If

Coding That Helps Get Firdapse (amifampridine) Covered by Humana in Pennsylvania: ICD-10, NDC, and Billing Requirements

Answer Box: Getting Firdapse (amifampridine) Covered by Humana in Pennsylvania Quick approval path: Use ICD-10 codes G70.80 or G70.81 for Lambert-Eaton myasthenic syndrome (LEMS), bill with the correct Firdapse NDC (49948-100-01 for 10mg tablets), and submit via Medicare Part D pharmacy benefit—not Part B. Humana requires prior

How to Get Hetlioz LQ (Tasimelteon Oral Suspension) Covered by Cigna in Pennsylvania: Prior Authorization Guide and Appeal Process

Answer Box: Getting Hetlioz LQ Covered by Cigna in Pennsylvania Eligibility: Hetlioz LQ requires prior authorization from Cigna for Smith-Magenis syndrome patients ages 3-15. Fastest path: Submit PA request through Express Scripts with confirmed SMS diagnosis, documented capsule trial failure, and sleep specialist consultation. First step today: Contact your prescriber

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

Answer Box: Getting Givlaari Covered by Aetna CVS Health in Pennsylvania Yes, Givlaari (givosiran) can be covered by Aetna CVS Health in Pennsylvania, but requires prior authorization. Submit your PA request through Availity.com with complete AHP documentation including elevated ALA/PBG levels and attack history. If denied, Pennsylvania'

Getting Jaypirca (Pirtobrutinib) Approved by Blue Cross Blue Shield in Pennsylvania: Complete Coverage Guide

Answer Box: Getting Jaypirca Covered in Pennsylvania Blue Cross Blue Shield Pennsylvania plans require prior authorization for Jaypirca (pirtobrutinib). The fastest path to approval: document prior BTK inhibitor failure (plus BCL-2 inhibitor for CLL/SLL), submit complete medical records, and use your plan's specific PA form. If denied,

How to Get Voxzogo (Vosoritide) Covered by Humana in Pennsylvania: 2025 Prior Authorization Guide

Answer Box: Getting Voxzogo (Vosoritide) Covered by Humana in Pennsylvania Eligibility: Humana requires prior authorization for Voxzogo (vosoritide) with confirmed achondroplasia, open growth plates, and pediatric specialist care. Fastest path: Submit complete PA packet including FGFR3 genetic test, growth plate imaging, and pediatric endocrinologist letter through Humana's provider

How to Get Xenpozyme (olipudase alfa-rpcp) Covered by Humana in Pennsylvania: Complete PA Guide with Appeals Process

Answer Box: Getting Xenpozyme Covered by Humana in Pennsylvania Xenpozyme (olipudase alfa-rpcp) requires prior authorization from Humana and must be dispensed through CenterWell Specialty Pharmacy. First step: Have your prescriber submit genetic confirmation of ASMD, spleen/lung measurements, and an infusion site plan. If denied, Pennsylvania's Independent External

Renewing Adynovate (bdanocog alfa pegol) Approval with Aetna (CVS Health) in Pennsylvania: Complete Timeline and Documentation Guide

Answer Box: Renewing Adynovate Approval in Pennsylvania Aetna (CVS Health) typically requires prior authorization renewal for Adynovate (bdanocog alfa pegol) every 6-12 months. Start your renewal 30-60 days before expiration to avoid treatment gaps. Submit updated clinical documentation including factor VIII levels, bleeding logs, and treatment response through your hematologist.

Myths vs. Facts: Getting Revlimid (Lenalidomide) Covered by Cigna in Pennsylvania - Appeals Guide 2025

Quick Answer: Getting Revlimid (lenalidomide) covered by Cigna in Pennsylvania requires prior authorization, REMS certification for both prescriber and pharmacy, and meeting specific clinical criteria. If denied, you have strong appeal options: Pennsylvania's new external review program overturns about 50% of denials. First step today: Check if your