Topic

Pennsylvania

A collection of 499 issues

How to Get Tegsedi (Inotersen) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Appeal Guide with Forms and Timelines

Quick Answer: Getting Tegsedi Covered by BCBS in Pennsylvania Blue Cross Blue Shield prior authorization for Tegsedi (inotersen) requires: genetic confirmation of hATTR polyneuropathy, documented step therapy failures, REMS enrollment, and a comprehensive lab monitoring plan. If denied, you have 180 days for internal appeals, then 4 months for Pennsylvania&

How to Get Evkeeza (Evinacumab) Approved by Aetna CVS Health in Pennsylvania: Prior Authorization Guide with Appeals Process

Answer Box: Getting Evkeeza Covered by Aetna in Pennsylvania To get Evkeeza (evinacumab-dgnb) approved by Aetna CVS Health in Pennsylvania for homozygous familial hypercholesterolemia (HoFH): 1. Confirm HoFH diagnosis with genetic testing or clinical criteria (untreated LDL-C >400 mg/dL plus family history/xanthomas) 2. Document step therapy failures

If Darzalex Isn't Covered by Humana in Pennsylvania: Formulary Alternatives & Exception Strategies

Quick Answer: Alternatives When Darzalex Isn't Covered If Humana denies Darzalex (daratumumab) coverage in Pennsylvania, you typically have three paths: try covered alternatives like Sarclisa (isatuximab), lenalidomide (Revlimid), or carfilzomib (Kyprolis); request a formulary exception with strong clinical justification; or appeal through Pennsylvania's external review process.

How to Get Cosentyx (Secukinumab) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Appeals Guide

Answer Box: Getting Cosentyx Covered by Blue Cross Blue Shield in Pennsylvania Cosentyx (secukinumab) requires prior authorization from all Blue Cross Blue Shield plans in Pennsylvania, with step therapy requirements effective January 2025. The fastest path to approval: (1) Document failed trials with preferred agents like methotrexate or TNF inhibitors,

The Complete Requirements Checklist to Get Besponsa (Inotuzumab Ozogamicin) Covered by UnitedHealthcare in Pennsylvania

Quick Answer: Getting Besponsa Covered by UnitedHealthcare in Pennsylvania Besponsa (inotuzumab ozogamicin) requires prior authorization from UnitedHealthcare for all plan types. Your fastest path to approval: 1) Gather documentation proving CD22-positive relapsed/refractory B-cell ALL and failed prior therapies, 2) Submit PA request through UnitedHealthcare Provider Portal with complete clinical

Do You Qualify for Defitelio Coverage by UnitedHealthcare in Pennsylvania? Decision Tree & Next Steps

Answer Box: Your Path to Defitelio Coverage Getting Defitelio (defibrotide) covered by UnitedHealthcare in Pennsylvania requires prior authorization for hepatic VOD/SOS with organ dysfunction post-HSCT. You're likely eligible if you have confirmed hepatic veno-occlusive disease with renal or pulmonary dysfunction following hematopoietic stem cell transplant. Start by

Lowering Out-of-Pocket for Xospata (gilteritinib) with Aetna (CVS Health) in Pennsylvania: Copay, Tiering & Assistance

Answer Box: Getting Xospata (gilteritinib) Covered by Aetna (CVS Health) in Pennsylvania Xospata requires prior authorization from Aetna (CVS Health) with documented FLT3 mutation testing and relapsed/refractory AML diagnosis. The medication costs approximately $28,979 per 30-day supply but copay assistance can reduce costs to $0 for commercially insured

How to Get Stelara (Ustekinumab) Covered by Cigna in Pennsylvania: Coding, Appeals, and Step Therapy Guide

Answer Box: Getting Stelara Covered by Cigna in Pennsylvania Fastest path to approval: Complete Cigna's prior authorization form with proper ICD-10 codes (L40.0 for plaque psoriasis, K50.x for Crohn's), document step therapy failures, and include specialist notes showing medical necessity. If denied, Pennsylvania'

Myths vs. Facts: Getting Rapivab (peramivir) Covered by UnitedHealthcare in Pennsylvania

Answer Box: Getting Rapivab Covered by UnitedHealthcare in Pennsylvania Rapivab (peramivir) requires prior authorization through UnitedHealthcare's OptumRx and is typically non-formulary, but approval is possible with proper documentation. Key requirements: symptoms within 48 hours, positive flu test, and documented failure/contraindication of oral antivirals. If denied, Pennsylvania'

Myths vs. Facts: Getting Evrysdi (risdiplam) Covered by Humana in Pennsylvania - 2025 Appeals Guide

Answer Box: Getting Evrysdi Covered by Humana in Pennsylvania Evrysdi (risdiplam) requires prior authorization from Humana Medicare Advantage plans in Pennsylvania. Key requirements include genetic confirmation of SMA diagnosis and baseline motor function assessment. If denied, Pennsylvania's new external review program overturns 53% of appeals. First step: Have