Topic

Pennsylvania

A collection of 40 issues

How to Get Signifor LAR (Pasireotide) Covered by Cigna in Pennsylvania: Prior Authorization Requirements and Appeals Process

Quick Answer: Getting Cigna Coverage for Signifor LAR in Pennsylvania Cigna requires prior authorization for Signifor/Signifor LAR (pasireotide) with strict medical necessity criteria. Your endocrinologist must document: confirmed acromegaly or Cushing's disease diagnosis, elevated IGF-1/UFC levels, failed surgery or ineligibility, and trial/failure of first-generation somatostatin

Get Advate (octocog alfa) Covered by Aetna CVS Health in Pennsylvania: Complete Guide with Forms and Appeal Process

Answer Box: Getting Advate Covered by Aetna CVS Health in Pennsylvania Yes, Advate (octocog alfa) is covered by Aetna CVS Health in Pennsylvania, but requires prior authorization. Aetna prefers Kovaltry for routine prophylaxis, so you'll need to document failure or intolerance to Kovaltry first. Your hematologist must submit

How to Get Kuvan (Sapropterin) Covered by Aetna in Pennsylvania: Prior Authorization, Appeals & Alternatives

Answer Box: Getting Kuvan Covered by Aetna in Pennsylvania Kuvan (sapropterin) requires prior authorization from Aetna with documented BH4 responsiveness testing showing ≥30% blood phenylalanine reduction. If denied, Pennsylvania's new external review program overturns ~50% of appeals. First step: Have your doctor submit PA documentation including PKU diagnosis,

How to Get Cosentyx (Secukinumab) Covered by Aetna CVS Health in Pennsylvania: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Cosentyx Covered by Aetna CVS Health in Pennsylvania Aetna CVS Health requires prior authorization for Cosentyx (secukinumab) in Pennsylvania, with step therapy requirements for most patients. Fastest path to approval: 1) Ensure TB screening is complete, 2) Document prior treatment failures (typically methotrexate or other biologics), and

How to Get Pomalyst (Pomalidomide) Covered by UnitedHealthcare in Pennsylvania: Complete PA Guide and Appeals Process

Answer Box: Getting Pomalyst Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Pomalyst (pomalidomide) with strict step therapy requirements. To get approved, you need documented failure of at least one immunomodulatory agent (like lenalidomide), proteasome inhibitor, or anti-CD38 therapy, plus complete REMS program enrollment. First step today: Have

How to Get Photrexa (Riboflavin) Approved by Humana in Pennsylvania: Timeline, Appeals & Success Strategies

Answer Box: Getting Photrexa Covered by Humana in Pennsylvania Humana requires prior authorization for Photrexa (riboflavin ophthalmic solution) used in corneal cross-linking for keratoconus. The fastest path to approval: gather documented progression evidence (Kmax increase ≥1.0 diopter, serial topography), submit through Humana's electronic PA system for 1-day

How to Get Oxervate (cenegermin) Covered by Humana in Pennsylvania: Appeals Guide and Medical Necessity Templates

Quick Answer: Getting Oxervate Covered by Humana in Pennsylvania Oxervate (cenegermin) requires prior authorization from Humana for stage 2-3 neurotrophic keratitis. The fastest path: your ophthalmologist submits a medical necessity letter documenting failed conventional treatments (lubricants, bandage lenses) and confirmed corneal sensation loss. If denied, you have 65 days to

Getting Zanzalintinib (XL092) Covered by Cigna in Pennsylvania: Complete Coding and Appeals Guide

Answer Box: Your Path to Coverage Zanzalintinib (XL092) is an investigational cancer drug requiring special approval from Cigna. In Pennsylvania, you'll need: (1) Your doctor submits a prior authorization with clinical trial documentation or compassionate use approval from Exelixis, (2) if denied, file internal appeals within 180 days,

How to Get Alprolix Covered by Blue Cross Blue Shield in Pennsylvania: PA Forms, Appeals & Success Strategies

Answer Box: Getting Alprolix Covered by BCBS in Pennsylvania Alprolix requires prior authorization from all Blue Cross Blue Shield plans in Pennsylvania. The fastest path to approval: (1) Have your hematologist submit a PA request through the BCBS provider portal with documentation of hemophilia B diagnosis, factor IX levels <

Getting Pombiliti (Cipaglucosidase Alfa) Covered by Cigna in Pennsylvania: Prior Authorization, Appeals, and Cost-Saving Strategies

Quick Answer: Getting Pombiliti Covered by Cigna in Pennsylvania Cigna requires prior authorization for Pombiliti (cipaglucosidase alfa-atga) and places it on Tier 5 specialty formulary. First step: Have your prescriber submit PA through CoverMyMeds or ExpressPAth with genetic confirmation of Pompe disease and documentation that you're not improving