Topic

Pennsylvania

A collection of 498 issues

Cigna's Coverage Criteria for Soliris (Eculizumab) in Pennsylvania: What Counts as "Medically Necessary"?

Answer Box: Getting Soliris Covered by Cigna in Pennsylvania Cigna requires prior authorization for Soliris (eculizumab) with specific diagnostic tests, meningococcal vaccinations ≥2 weeks before treatment, and prescriber REMS enrollment. For PNH, you need flow cytometry showing GPI-anchored protein deficiency; for myasthenia gravis, positive anti-AChR antibodies; for NMOSD, positive anti-AQP4

How to Get Tavneos (Avacopan) Covered by Humana in Pennsylvania: Timeline, Forms & Appeals Process

Answer Box: Getting Tavneos (Avacopan) Covered by Humana in Pennsylvania Humana requires prior authorization for Tavneos (avacopan) with documentation of severe active ANCA-associated vasculitis, positive ANCA testing, and specialist prescriber (rheumatologist, nephrologist, or pulmonologist). Submit via Humana's provider portal or call 800-555-2546 for expedited review (72 hours). If

How to Get Mycapssa (Octreotide Oral) Covered by Humana in Pennsylvania: Complete Prior Authorization Guide

Quick Answer: Getting Mycapssa Covered by Humana in Pennsylvania Mycapssa (oral octreotide) requires prior authorization from Humana Medicare Advantage plans in Pennsylvania. You'll need documented proof of acromegaly diagnosis, prior response to injectable somatostatin analogs (like Sandostatin LAR or Somatuline Depot), and an endocrinologist's prescription. If

How to Get Taltz (Ixekizumab) Covered by Blue Cross Blue Shield in Pennsylvania: Prior Authorization Guide & Appeal Scripts

Quick Answer: Getting Taltz Covered in Pennsylvania Blue Cross Blue Shield plans in Pennsylvania require prior authorization for Taltz (ixekizumab), typically including step therapy with at least one TNF inhibitor failure. Most commercial and health exchange plans classify Taltz as non-preferred, while Medicaid managed plans may offer preferred status. The

How to Get Pyrukynd (Mitapivat) Covered by Cigna in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Pyrukynd Covered by Cigna in Pennsylvania Cigna requires prior authorization for Pyrukynd (mitapivat) in Pennsylvania for adults with pyruvate kinase deficiency, confirmed by genetic testing (≥2 PKLR gene variants with ≥1 missense variant) and prescribed by a hematologist. You'll need hemoglobin ≤10 g/dL or

Getting Kymriah Approved by UnitedHealthcare in Pennsylvania: Complete Coverage Guide with Appeals Process

Answer Box: Fast Track to Kymriah Coverage UnitedHealthcare covers Kymriah (tisagenlecleucel) as a medical benefit requiring prior authorization through OptumHealth Transplant Solutions. Key requirements: CD19+ confirmed disease, ≥2 prior therapy failures, treatment at FACT-accredited center. First step today: Verify your plan includes transplant benefits and confirm your treatment center is

UnitedHealthcare's Coverage Criteria for Tecentriq (atezolizumab) in Pennsylvania: What Counts as "Medically Necessary"?

Answer Box: Getting Tecentriq Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Tecentriq (atezolizumab) with specific medical necessity criteria including FDA-approved indication, PD-L1 testing (when required), and oncologist prescribing. If denied, Pennsylvania's Independent External Review Program has overturned 53% of denials. Start today: Gather your pathology

Work With Your Doctor to Get Vimizim (Elosulfase Alfa) Approved by UnitedHealthcare in Pennsylvania: Medical Necessity Letters, Appeals, and Provider Collaboration

Answer Box: Getting Vimizim Approved in Pennsylvania UnitedHealthcare requires prior authorization for Vimizim (elosulfase alfa) through OptumRx, with strict diagnostic and functional requirements for MPS IVA patients. Your fastest path: (1) Schedule with a pediatric geneticist or metabolic specialist at Children's Hospital of Philadelphia or Nemours, (2) Gather

How to Get Tagrisso (Osimertinib) Covered by Cigna in Pennsylvania: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Tagrisso Covered by Cigna in Pennsylvania Cigna covers Tagrisso (osimertinib) with prior authorization for EGFR mutation-positive NSCLC. Your fastest path to approval: 1. Confirm EGFR mutation status via FDA-approved testing (exon 19 deletion, L858R, or T790M) 2. Submit PA through Cigna provider portal using form CNF-550 with

How to Get Xenpozyme (olipudase alfa-rpcp) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Coding, Appeals, and Authorization Guide

Answer Box: Getting Xenpozyme Covered in Pennsylvania Xenpozyme (olipudase alfa-rpcp) requires prior authorization from Blue Cross Blue Shield plans in Pennsylvania. Use ICD-10 codes E75.240 (type A), E75.241 (type B), or E75.244 (type A/B) for ASMD diagnosis. Submit PA with genetic confirmation, baseline organ assessments, and