Topic

Pennsylvania

A collection of 499 issues

How to Get Bylvay (Odevixibat) Covered by Cigna in Pennsylvania: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Bylvay Covered by Cigna in Pennsylvania Bylvay (odevixibat) requires prior authorization from Cigna for PFIC or Alagille syndrome patients. Your hepatologist must submit documentation proving diagnosis, moderate-to-severe pruritus, and failure of at least two systemic medications. If denied, Pennsylvania's Independent External Review Program offers a
5 min read

How to Get Juxtapid (Lomitapide) Covered by Aetna CVS Health in Pennsylvania: Complete Prior Authorization Guide

Answer Box: Getting Juxtapid (Lomitapide) Covered by Aetna CVS Health in Pennsylvania Juxtapid (lomitapide) requires prior authorization from Aetna CVS Health for homozygous familial hypercholesterolemia (HoFH) treatment in Pennsylvania. Submit requests through CVS Caremark's ePA portal at Availity.com or fax to 1-866-249-6155. Key requirements: genetic HoFH confirmation,
5 min read

How to Get Crysvita (burosumab) Covered by Humana in Pennsylvania: Prior Authorization, Appeals, and Alternative Options

Answer Box: Getting Crysvita (burosumab) Covered by Humana in Pennsylvania Crysvita (burosumab) requires prior authorization from Humana in Pennsylvania. For Medicare Advantage members, submit PA documentation including genetic/FGF23 confirmation of XLH, baseline low serum phosphorus, and specialist attestation via Humana's provider portal. Standard review takes 72 hours;
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How to Get Koselugo (selumetinib) Covered by Cigna in Pennsylvania: Prior Authorization Guide and Appeals Process

Answer Box: Getting Koselugo (selumetinib) Covered by Cigna in Pennsylvania Koselugo (selumetinib) requires prior authorization from Cigna for pediatric patients with neurofibromatosis type 1 (NF1) and symptomatic, inoperable plexiform neurofibromas. Your prescriber must document NF1 diagnosis, imaging showing inoperable plexiform neurofibromas, baseline heart function (LVEF), and eye exam results. If
6 min read

How to Get Vanflyta (quizartinib) Covered by UnitedHealthcare in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Vanflyta Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Vanflyta (quizartinib) through OptumRx, with specific criteria including confirmed FLT3-ITD mutation, baseline EKG showing QTc ≤450ms, and use in newly diagnosed AML. Submit via the OptumRx provider portal with complete documentation. If denied, Pennsylvania's
5 min read

How to Get Cometriq (Cabozantinib) Covered by Cigna in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Cometriq Covered by Cigna in Pennsylvania Cigna covers Cometriq (cabozantinib capsules) for metastatic medullary thyroid carcinoma with prior authorization. Your oncologist submits a PA request including pathology confirming MTC diagnosis, recent imaging showing progression, and elevated calcitonin/CEA levels. If denied, Pennsylvania's new Independent External
6 min read

How to Get Prolastin-C Approved by UnitedHealthcare in Pennsylvania: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Prolastin-C Approved by UnitedHealthcare in Pennsylvania Prolastin-C requires prior authorization from UnitedHealthcare OptumRx for Pennsylvania patients. To get approved: (1) Gather genetic testing showing Pi*ZZ genotype, recent lung function tests (FEV1), and chest CT showing emphysema, (2) Submit PA via UHCprovider.com portal with ICD-10 codes
6 min read

How to Get Evrysdi (risdiplam) Covered by Blue Cross Blue Shield in Pennsylvania: Complete 2025 Guide with Forms and Appeal Scripts

Answer Box: Your Fastest Path to Evrysdi Coverage To get Evrysdi (risdiplam) covered by Blue Cross Blue Shield in Pennsylvania: Submit a prior authorization with genetic SMA confirmation, baseline motor assessment scores (CHOP INTEND or HFMSE), and weight-based dosing documentation. If denied, use Pennsylvania's Independent External Review program—
5 min read