Topic

Pennsylvania

A collection of 499 issues

Getting Zanzalintinib (XL092) Covered by Aetna CVS Health in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Started Zanzalintinib (XL092) is an investigational TKI that requires prior authorization from Aetna CVS Health in Pennsylvania. Since it's not FDA-approved, coverage is typically limited to clinical trials or compassionate use programs. Your fastest path: Have your oncologist submit a prior authorization request with clinical

How to Get Givlaari (givosiran) Covered by Blue Cross Blue Shield in Pennsylvania: Appeals Process, Forms & Timeline

Answer Box: To get Givlaari (givosiran) covered by Blue Cross Blue Shield in Pennsylvania, you need prior authorization with documented acute hepatic porphyria diagnosis, elevated urinary porphobilinogen/ALA or genetic testing, and at least 2 qualifying attacks in 6 months. If denied, use Pennsylvania's new external review process—

Myths vs. Facts: Getting Thiola / Thiola EC (Tiopronin) Covered by UnitedHealthcare in Pennsylvania

Answer Box: Getting Thiola Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Thiola/Thiola EC (tiopronin) through OptumRx. You'll need confirmed cystinuria diagnosis (ICD-10 E72.01), documented failure of conservative therapy (alkalinization, high fluid intake), 24-hour urine cystine >500 mg/day, and specialist involvement from

How to Get Keytruda (Pembrolizumab) Covered by Aetna CVS Health in Pennsylvania: Timeline, Forms & Appeals

Answer Box: Getting Keytruda Covered by Aetna CVS Health in Pennsylvania Keytruda (pembrolizumab) requires prior authorization from Aetna CVS Health in Pennsylvania. The fastest path: Your oncologist submits a complete PA request with PD-L1 testing results and medical necessity documentation. Standard approval takes up to 14 days; expedited requests can

Renewing Tagrisso (Osimertinib) Approval with Humana in Pennsylvania: 2025 Guide to Timing, Documentation, and Appeals

Answer Box: Renewing Your Tagrisso Coverage with Humana in Pennsylvania Tagrisso (osimertinib) renewal with Humana requires prior authorization every 6-12 months. Start the renewal process 30-45 days before your current approval expires. You'll need updated EGFR mutation testing, response assessment imaging, and a medical necessity letter from your

How to Get Busulfex (Busulfan Injection) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Appeals Guide

Quick Answer: Getting Busulfex Covered by BCBS in Pennsylvania Busulfex (busulfan injection) requires prior authorization from Blue Cross Blue Shield plans in Pennsylvania. The fastest path to approval: (1) Your oncologist submits a medical necessity letter documenting your diagnosis, prior treatments, and why IV busulfan is required for your transplant

Work With Your Doctor to Get Emgality (galcanezumab-gnlm) Covered by Cigna in Pennsylvania: Appeals Guide

Answer Box: Getting Emgality Covered by Cigna in Pennsylvania Eligibility: Cigna requires prior authorization for Emgality (galcanezumab-gnlm) with step therapy requirements—typically failure of 2+ oral preventives from different classes. Fastest path: Work with your doctor to document migraine frequency (4+ days/month), prior treatment failures, and functional disability. Submit

How to Get Tavalisse (Fostamatinib) Covered by Humana in Pennsylvania: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Tavalisse Covered by Humana in Pennsylvania Tavalisse (fostamatinib) is not on Humana's standard formulary in Pennsylvania and requires prior authorization or a formulary exception. Your fastest path to approval: 1. Confirm your diagnosis: Chronic ITP with platelet count <30,000/μL documented by a

Get Elevidys Covered by UnitedHealthcare in Pennsylvania: Complete Prior Authorization Guide with Forms and Appeals

Answer Box: Getting Elevidys Covered by UnitedHealthcare in Pennsylvania Elevidys requires prior authorization from UnitedHealthcare in Pennsylvania. Your fastest path to approval: (1) Verify your plan covers specialty gene therapies through OptumRx, (2) Have your doctor submit a complete PA request via the UnitedHealthcare Provider Portal with genetic confirmation and

Myths vs. Facts: Getting Besponsa (Inotuzumab Ozogamicin) Covered by Blue Cross Blue Shield in Pennsylvania

Answer Box: Getting Besponsa Covered by Blue Cross Blue Shield in Pennsylvania Myth: If your doctor prescribes Besponsa, Blue Cross Blue Shield must cover it. Fact: Prior authorization is required with specific documentation including CD22-positive status, relapsed/refractory B-cell ALL diagnosis, and prior therapy failures. Pennsylvania's external review