Prior Authorization in Pennsylvania
Pennsylvania enacted Act 94 (2018) requiring step therapy override protections. The law mandates exceptions for contraindications, prior treatment failures, and expected inefficacy. PA requires insurers to respond to PA requests within 15 days for standard and 24 hours for urgent.
Key Facts About PA in Pennsylvania
- ✓ Step therapy override law enacted in 2018
- ✓ Standard PA decisions within 15 days; urgent within 24 hours
- ✓ External review available through the PA Insurance Department
- ✓ Highmark and Independence Blue Cross are major carriers
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in Pennsylvania
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these Pennsylvania carriers:
Highmark BCBSIndependence Blue CrossUnitedHealthcareAetna