Topic

Pennsylvania

A collection of 499 issues

How to Get Tavneos (Avacopan) Covered by Cigna in Pennsylvania: Complete PA Guide with Appeals Process

Answer Box: Getting Tavneos (Avacopan) Covered by Cigna in Pennsylvania Tavneos requires prior authorization from Cigna and must be prescribed by a specialist for ANCA-associated vasculitis. The fastest path to approval: (1) Ensure your rheumatologist, nephrologist, or pulmonologist completes Cigna's PA form with positive ANCA labs and combination

Complete Coding Guide: Getting Kuvan (Sapropterin) Covered by Humana in Pennsylvania - ICD-10, NDC, and Prior Authorization Requirements

Answer Box: Fastest Path to Kuvan Coverage with Humana in Pennsylvania Kuvan (sapropterin dihydrochloride) requires prior authorization from Humana Medicare Advantage plans in Pennsylvania. Submit requests using the correct NDC code (not J-codes), ICD-10 code E70.0 (classical PKU) or E70.1 (other hyperphenylalaninemias), and comprehensive documentation showing BH4 responsiveness.

How to Get Opzelura (Ruxolitinib Cream) Covered by Cigna in Pennsylvania: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Opzelura Covered by Cigna in Pennsylvania Fastest Path to Approval: Cigna requires prior authorization for Opzelura (ruxolitinib cream) with mandatory step therapy. You must document failed trials of topical corticosteroids (≥28 days) AND calcineurin inhibitors (≥12 weeks) before approval. If denied, Pennsylvania's new external review

How to Get Synagis (Palivizumab) Covered by UnitedHealthcare in Pennsylvania: Complete Appeals Guide with Templates

Quick Answer: Getting Synagis Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Synagis (palivizumab) in Pennsylvania, with strict eligibility limited to high-risk infants under 24 months. You'll need specialist documentation proving your child meets specific criteria (premature with chronic lung disease, significant congenital heart disease, or

How to Get Zanzalintinib (XL092) Covered by Humana in Pennsylvania: Complete Appeals Guide for Investigational Cancer Drugs

Quick Answer: Getting Zanzalintinib (XL092) Covered by Humana in Pennsylvania Zanzalintinib (XL092) is investigational and typically denied by Humana Medicare Advantage plans. Your fastest path: 1) Apply for Exelixis's compassionate use program (drug supplied free), 2) Submit Humana prior authorization with compassionate use approval letter, 3) If denied,

How to Get Lutathera (Lutetium Lu-177 Dotatate) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Provider Collaboration Guide

Answer Box: Getting Lutathera Covered by Blue Cross Blue Shield in Pennsylvania Blue Cross Blue Shield plans in Pennsylvania (Highmark, Independence Blue Cross) require prior authorization for Lutathera (lutetium Lu-177 dotatate) with strict clinical criteria. Fastest approval path: Confirm you have GEP-NET diagnosis with SSTR-positive imaging, documented octreotide/lanreotide failure,

How to Get Oxervate (Cenegermin) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Coverage Guide

Quick Answer: Getting Oxervate Covered by Blue Cross Blue Shield in Pennsylvania Oxervate (cenegermin) requires prior authorization from Pennsylvania Blue Cross Blue Shield plans. Your fastest path to approval: (1) Confirm stage 2 or 3 neurotrophic keratitis diagnosis with corneal sensitivity testing, (2) document 14+ days of failed preservative-free artificial

How to Get Blenrep (Belantamab Mafodotin) Covered by Cigna in Pennsylvania: Complete Appeals Guide

Answer Box: Getting Blenrep Covered by Cigna in Pennsylvania Blenrep (belantamab mafodotin) is currently withdrawn from the U.S. market as of 2022, with FDA resubmission under review (PDUFA date October 2025). Access is limited to clinical trials or expanded access programs. If you're seeking coverage, you'

Get Orfadin (Nitisinone) Covered by Cigna in Pennsylvania: Complete Prior Authorization Guide

Answer Box: Getting Orfadin Covered by Cigna in Pennsylvania Yes, Cigna covers Orfadin (nitisinone) for hereditary tyrosinemia type 1 (HT-1) in Pennsylvania, but prior authorization is required. The fastest path to approval: (1) Ensure your metabolic specialist documents confirmed HT-1 diagnosis with elevated succinylacetone and/or FAH gene testing, (2)

Work With Your Doctor to Get Lutathera (Lutetium Lu-177 Dotatate) Approved by UnitedHealthcare in Pennsylvania: Complete Provider Collaboration Guide

Quick Answer: Your Path to Lutathera Approval To get Lutathera (lutetium Lu-177 dotatate) covered by UnitedHealthcare in Pennsylvania, you'll need prior authorization showing somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors and documented progression on octreotide or lanreotide. Start today by: (1) requesting your complete medical records from your oncologist, (2)