Topic

Pennsylvania

A collection of 501 issues

How to Get Crysvita (burosumab) Covered by UnitedHealthcare in Pennsylvania: Complete Guide with Forms, Appeals, and Contacts

Answer Box: Getting Crysvita Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Crysvita (burosumab) in Pennsylvania. Submit through the UnitedHealthcare Provider Portal with required documentation: XLH diagnosis confirmation (genetic testing or elevated FGF23), specialist prescription, and for adults, evidence of failed oral phosphate/calcitriol therapy. If denied, use

The Requirements Checklist to Get Rinvoq (upadacitinib) Covered by Aetna (CVS Health) in Pennsylvania

Quick Answer: Getting Rinvoq Covered by Aetna in Pennsylvania To get Rinvoq (upadacitinib) covered by Aetna (CVS Health) in Pennsylvania, you need prior authorization with documented failure of at least one TNF inhibitor for conditions like rheumatoid arthritis. Submit via Aetna's provider portal or fax to 1-866-249-6155. If

How to Get Kineret (anakinra) Covered by Cigna in Pennsylvania: Prior Authorization Guide and Appeal Templates

Quick Answer: Cigna requires prior authorization for Kineret (anakinra), with step therapy requirements including failed DMARDs and often TNF inhibitors. In Pennsylvania, if denied, you can appeal through the state's external review process, which overturns about 53% of denials. Start by gathering documentation of failed prior therapies and

How to Get Epidiolex (Cannabidiol) Covered by Aetna CVS Health in Pennsylvania: Appeals, Forms & State Protections

Answer Box: Getting Epidiolex Covered by Aetna CVS Health in Pennsylvania Epidiolex (cannabidiol) requires prior authorization from Aetna CVS Health for FDA-approved seizure disorders (LGS, Dravet, TSC) in patients 1+ years old. If denied, Pennsylvania's external review process has a 53% overturn rate. Your first step today: Have

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

Quick Answer: Getting Kalydeco Covered by Blue Cross Blue Shield in Pennsylvania Kalydeco (ivacaftor) requires prior authorization from Blue Cross Blue Shield plans in Pennsylvania. Key requirements: confirmed cystic fibrosis diagnosis, CFTR genetic testing showing a responsive mutation (like G551D or R117H), and prescription by a CF specialist. If denied,

How to Get Jaypirca (Pirtobrutinib) Covered by UnitedHealthcare in Pennsylvania: Complete Guide to Prior Authorization, Appeals, and Forms

Quick Answer: Getting Jaypirca Covered by UnitedHealthcare in Pennsylvania Jaypirca (pirtobrutinib) requires prior authorization from UnitedHealthcare and is placed on Tier 3 of the OptumRx formulary. To get approved, you'll need documented failure of a prior BTK inhibitor (like ibrutinib) and, for CLL/SLL patients, a BCL-2 inhibitor.

Do You Qualify for Sylvant (Siltuximab) Coverage by UnitedHealthcare in Pennsylvania? Complete Decision Tree & Appeals Guide

Answer Box: Getting Sylvant Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Sylvant (siltuximab) but typically doesn't require step therapy for idiopathic multicentric Castleman disease (iMCD). You qualify if you're 18+, HIV-negative, HHV-8-negative, with confirmed iMCD via lymph node biopsy. Submit through the UnitedHealthcare

Get Filspari (Sparsentan) Covered by Aetna CVS Health in Pennsylvania: Complete Guide to Prior Authorization and Appeals

Answer Box: Quick Path to Filspari Coverage Getting Filspari (sparsentan) covered by Aetna CVS Health in Pennsylvania requires: 1. Biopsy-proven IgA nephropathy diagnosed by a nephrologist 2. Failed ACE inhibitor/ARB therapy (≥3 months unless contraindicated) 3. REMS enrollment with quarterly liver function tests 4. Prior authorization submission with complete

If Oxlumo (Lumasiran) Isn't Approved by UnitedHealthcare in Pennsylvania: Formulary Alternatives & Exception Paths

Answer Box: Your Next Steps When UnitedHealthcare Denies Oxlumo If UnitedHealthcare denied Oxlumo (lumasiran) for primary hyperoxaluria type 1 (PH1) in Pennsylvania, you have three main paths: try formulary alternatives like Rivfloza (nedosiran) or high-dose vitamin B6, request a formulary exception with specialist documentation, or appeal the denial through UnitedHealthcare&

How to Get Xembify (Immune Globulin, SC) Covered by Aetna CVS Health in Pennsylvania: Forms, Appeals, and Templates

Answer Box: Xembify (immune globulin subcutaneous) requires prior authorization from Aetna CVS Health in Pennsylvania. Submit precertification via phone (866) 752-7021 or fax (888) 267-3277 with a Statement of Medical Necessity documenting primary immunodeficiency diagnosis, prior treatment failures, and clinical need. If denied, Pennsylvania's new external review program