Topic

Pennsylvania

A collection of 499 issues

Get Synagis (Palivizumab) Covered by Aetna CVS Health in Pennsylvania: 2024 Forms, Appeals & Contact Guide

Quick Start: Getting Synagis Approved by Aetna CVS Health in Pennsylvania Most important step: Complete Aetna's Synagis precertification form and submit via fax (1-888-267-3277) or phone (1-866-752-7021). Key requirement in 2024: Aetna now requires documentation that Beyfortus (nirsevimab) is contraindicated, unavailable, or ineffective before approving Synagis. Eligible high-risk
6 min read

How to Get Chenodal (chenodiol) Approved by UnitedHealthcare in Pennsylvania: Complete PA Guide with Appeals Process

Quick Answer: Getting Chenodal Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Chenodal (chenodiol) with mandatory step therapy through ursodiol first. In Pennsylvania, you have strong appeal rights including a new state-run external review program with a 50% overturn rate. Start today by: 1) Confirming your plan covers
6 min read

How to Get Onpattro (patisiran) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Onpattro Covered in Pennsylvania Blue Cross Blue Shield in Pennsylvania requires prior authorization for Onpattro (patisiran) with strict medical necessity criteria. You need genetic confirmation of hATTR polyneuropathy, neurologist evaluation, and documented functional assessments. If denied, Pennsylvania's new external review program has overturned 50% of
6 min read

Requirements Checklist to Get Ultomiris (ravulizumab) Covered by Humana in Pennsylvania: Forms, Appeals, and Approval Timeline

Answer Box: Getting Ultomiris Covered by Humana in Pennsylvania Who needs this: Pennsylvania patients with PNH, aHUS, generalized myasthenia gravis, or NMOSD whose doctors prescribe Ultomiris (ravulizumab). Fastest path to approval: 1) Verify active Humana coverage and formulary status, 2) Submit prior authorization with complete clinical documentation including vaccination records
5 min read

Renewing Myozyme (Alglucosidase Alfa) Approval with UnitedHealthcare in Pennsylvania: Complete Timeline and Documentation Guide

Answer Box: Renewing Myozyme Coverage with UnitedHealthcare UnitedHealthcare requires prior authorization renewal for Myozyme (alglucosidase alfa) with updated clinical documentation demonstrating continued medical necessity. Start the renewal process 60-90 days before your current authorization expires. Submit updated clinical progress notes, lab results confirming ongoing Pompe disease management, and evidence of
6 min read

How to Get Opdivo (Nivolumab) Covered by Aetna CVS Health in Pennsylvania: Complete Guide with Forms, Appeal Scripts, and Success Strategies

Answer Box: Getting Opdivo Covered by Aetna CVS Health in Pennsylvania Aetna requires prior authorization for Opdivo (nivolumab) in Pennsylvania. Your fastest path: Have your oncologist submit a complete prior authorization request with detailed medical necessity documentation, prior therapy failure records, and FDA-indicated diagnosis codes. If denied, request a peer-to-peer
6 min read

The Requirements Checklist to Get Upstaza (Eladocagene Exuparvovec) Covered by UnitedHealthcare in Pennsylvania: Complete Prior Authorization Guide

Answer Box: Getting Upstaza Covered by UnitedHealthcare in Pennsylvania To get Upstaza (eladocagene exuparvovec) covered by UnitedHealthcare in Pennsylvania, you'll need: genetic confirmation of biallelic DDC mutations, documented AADC deficiency symptoms, prior authorization through OptumRx, and treatment at a certified gene therapy center. Start today by: confirming your
6 min read