Topic

Pennsylvania

A collection of 499 issues

Do You Qualify for HyperHEP (hepatitis B immune globulin) Coverage by Aetna (CVS Health) in Pennsylvania? Decision Tree & Next Steps

Answer Box: Getting HyperHEP Covered by Aetna (CVS Health) in Pennsylvania Yes, HyperHEP (hepatitis B immune globulin) is covered by Aetna (CVS Health) in Pennsylvania with prior authorization. The fastest path: 1) Document exposure details and patient's anti-HBs status (<10 mIU/mL), 2) Submit PA through Availity

How to Get Keppra (Levetiracetam) Covered by Blue Cross Blue Shield in Pennsylvania: PA Forms, Appeals, and Success Strategies

Answer Box: Getting Keppra Covered in Pennsylvania To get Keppra (levetiracetam) covered by Blue Cross Blue Shield in Pennsylvania: First, check if prior authorization is required through your plan's member portal or formulary. Generic levetiracetam is typically preferred over brand Keppra and may be covered in Tier 1-2.

How to Get Pemazyre (pemigatinib) Covered by UnitedHealthcare in Pennsylvania: Complete Forms, Appeals, and Approval Guide

Answer Box: Getting Pemazyre Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Pemazyre (pemigatinib) effective January 1, 2025. To get coverage in Pennsylvania: (1) Confirm your FGFR2 fusion/rearrangement test results are documented, (2) Have your oncologist submit a PA request through the UHC Provider Portal with all

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

Answer Box: Getting Kesimpta Covered by Aetna CVS Health in Pennsylvania Kesimpta (ofatumumab) requires prior authorization from Aetna via CVS Caremark for relapsing multiple sclerosis treatment. Submit through the CVS Caremark portal or call 1-800-294-5979, including neurologist documentation of relapsing MS diagnosis, prior DMT failures, HBV screening, and recent MRI

How to Get Ozempic and Mounjaro Covered by UnitedHealthcare in Pennsylvania: 2025 Prior Authorization Guide

Answer Box: Getting UnitedHealthcare Coverage for Ozempic/Mounjaro in Pennsylvania You can get Ozempic or Mounjaro covered by UnitedHealthcare in Pennsylvania, but you'll likely need prior authorization and may face step therapy requirements. The fastest path: Have your doctor submit a PA request through the UnitedHealthcare provider portal

Getting Natpara (Parathyroid Hormone) Covered by Aetna CVS Health in Pennsylvania: 2026 Discontinuation Guide and Alternative Coverage

Answer Box: Natpara Coverage Status with Aetna CVS Health in Pennsylvania Natpara (parathyroid hormone) is no longer available as Takeda discontinued manufacturing in December 2024, with the U.S. Special Use Program ending December 31, 2025. Aetna CVS Health now automatically denies new Natpara prescriptions due to lack of commercial

UnitedHealthcare's Coverage Criteria for Elfabrio in Pennsylvania: What Counts as "Medically Necessary"?

Answer Box: Getting Elfabrio Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Elfabrio (pegunigalsidase alfa-iwxj) with confirmed Fabry disease diagnosis via genetic testing or enzyme deficiency, plus documented organ involvement. Submit PA through OptumRx provider portal with specialist evaluation, genetic/enzyme results, and clinical evidence of kidney, heart,

Myths vs. Facts: Getting Waylivra (volanesorsen) Covered by Humana in Pennsylvania

Answer Box: Waylivra Coverage Reality Check Waylivra (volanesorsen) is not FDA-approved in the United States, making standard Humana coverage unavailable. However, Pennsylvania residents can pursue formulary exceptions through Humana's 72-hour coverage determination process, followed by Pennsylvania's Independent External Review if denied—which overturns 53% of denials.

The Complete Guide to Getting Vanflyta (Quizartinib) Covered by Cigna in Pennsylvania: Prior Authorization Forms, Appeals Process, and Medical Necessity Requirements

Answer Box: Getting Vanflyta Covered by Cigna in Pennsylvania Prior authorization is required for Vanflyta (quizartinib) under Cigna Health Plans in Pennsylvania. The fastest path to approval requires: (1) FLT3-ITD mutation confirmation via FDA-approved test, (2) baseline ECG with QTc <450ms, and (3) submission through CoverMyMeds or Cigna'

How to Get Vimizim (elosulfase alfa) Covered by Aetna (CVS Health) in Pennsylvania: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Vimizim Covered by Aetna in Pennsylvania Aetna (CVS Health) requires prior authorization for Vimizim (elosulfase alfa) in Pennsylvania. To get approved: (1) Submit confirmed MPS IVA diagnosis via GALNS enzyme deficiency test or genetic testing through your specialist, (2) Complete Aetna's Vimizim precertification form and