Topic

Pennsylvania

A collection of 499 issues

Renewing Soliris (Eculizumab) Approval with Aetna (CVS Health) in Pennsylvania: Complete 2025 Guide

Answer Box: Renewing Soliris (Eculizumab) with Aetna (CVS Health) in Pennsylvania Your Soliris renewal requires updated clinical documentation showing ongoing therapeutic response and up-to-date meningococcal vaccination. Submit your renewal request at least 2 weeks before your current authorization expires to avoid treatment interruptions. If denied, Pennsylvania's new external

Get Chenodal (chenodiol) Covered by Blue Cross Blue Shield in Pennsylvania: ICD-10, NDC, and Billing Guide

Answer Box: Getting Chenodal Covered in Pennsylvania Chenodal (chenodiol) requires prior authorization from all Blue Cross Blue Shield plans in Pennsylvania, including Highmark and Independence Blue Cross. Step 1: Ensure proper ICD-10 coding (K80.20 for radiolucent gallstones). Step 2: Submit PA with imaging proof of radiolucent stones, surgical ineligibility

How to Get Natpara (Parathyroid Hormone) Covered by UnitedHealthcare in Pennsylvania: 2025 Discontinuation Guide

Quick Answer: Natpara Coverage Status in Pennsylvania Natpara (parathyroid hormone) is being discontinued globally by Takeda as of December 31, 2024. UnitedHealthcare in Pennsylvania will only cover existing patients through December 2025, with no new patient starts allowed. If you're currently on Natpara, work with your endocrinologist immediately

How to Get Tegsedi (inotersen) Covered by Cigna in Pennsylvania: Decision Tree, Forms & Appeals

Answer Box: Quick Eligibility Check To get Tegsedi (inotersen) covered by Cigna in Pennsylvania: You need confirmed hATTR polyneuropathy with genetic testing, specialist prescription, REMS enrollment, and often proof you've tried Onpattro (patisiran) first. Submit prior authorization through Express Scripts specialty pharmacy with complete documentation. If denied, use

Blue Cross Blue Shield Pennsylvania Revcovi Coverage: Prior Authorization Requirements and Appeal Process

Answer Box: Getting Revcovi Covered by Blue Cross Blue Shield in Pennsylvania Blue Cross Blue Shield plans in Pennsylvania require prior authorization for Revcovi (elapegademase) to treat ADA-SCID. To qualify: (1) Confirm ADA-SCID diagnosis with enzyme testing showing <1% normal ADA activity, (2) Document that bone marrow transplant failed

How to Get Upstaza (Eladocagene Exuparvovec) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Guide with Forms and Appeal Scripts

Quick Answer: Blue Cross Blue Shield plans in Pennsylvania require prior authorization for Upstaza (eladocagene exuparvovec) with strict documentation requirements. You'll need confirmed AADC deficiency diagnosis, failed standard therapies, and treatment at a certified gene therapy center. Start by gathering genetic test results and contacting your BCBS plan&

Renewing Blenrep (Belantamab Mafodotin) Approval with UnitedHealthcare in Pennsylvania: Timeline, Documents & Appeal Process

Quick Answer: Blenrep Renewal with UnitedHealthcare in Pennsylvania Current Status: Blenrep (belantamab mafodotin) was withdrawn from the U.S. market in 2022 and is only available through clinical trials or expanded access programs. UnitedHealthcare typically denies coverage outside these settings. For trial-related bridge therapy or expanded access, submit prior authorization

How to Get Tavalisse (Fostamatinib) Covered by Aetna CVS Health in Pennsylvania: Prior Authorization, Appeals & Cost Assistance

Quick Answer: Getting Tavalisse Covered by Aetna CVS Health in Pennsylvania Aetna requires prior authorization for Tavalisse (fostamatinib) in Pennsylvania. You'll need documented failure of corticosteroids and at least one thrombopoietin receptor agonist, plus a hematologist's prescription. First step today: Have your hematologist submit a PA

How to Get Kineret (anakinra) Covered by Aetna in Pennsylvania: PA Requirements, Appeals, and Cost Assistance

Quick Answer: Getting Kineret (anakinra) Covered by Aetna in Pennsylvania Kineret requires prior authorization from Aetna and is subject to step therapy requirements. You'll typically need documented failure or intolerance of at least one conventional DMARD and one biologic DMARD first. The medication must be filled through CVS

Lowering Out-of-Pocket Costs for Jynarque (Tolvaptan) with UnitedHealthcare in Pennsylvania: Complete Copay and Appeals Guide

Answer Box: Getting Jynarque Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Jynarque (tolvaptan) but has no step therapy requirement. Commercially insured patients can access Otsuka's copay program for as little as $10/month (up to $8,000 annually). If denied, Pennsylvania's new external