Topic

Pennsylvania

A collection of 244 issues

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

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'