By Counterforce Health Team in Voxzogo (vosoritide) —

How to Get Voxzogo (vosoritide) Covered by Blue Cross Blue Shield in Virginia: Complete PA Guide with Forms and Appeal Process

Answer Box: Fast Track to Voxzogo Coverage in Virginia

To get Voxzogo (vosoritide) covered by Blue Cross Blue Shield in Virginia: Submit prior authorization through Availity's Interactive Care Reviewer with genetic testing confirming FGFR3 achondroplasia, bone age X-ray showing open growth plates, 12+ months of growth data, and specialist prescription from pediatric endocrinologist/geneticist. If denied, Virginia's Bureau of Insurance provides external review within 45 days. Start with BioMarin RareConnections for PA template and specialty pharmacy coordination.

First step today: Contact BioMarin RareConnections at the number on your Voxzogo information to begin enrollment and insurance verification.

Table of Contents

  1. Verify Your Blue Cross Blue Shield Plan
  2. Required Forms and Documentation
  3. Submission Portals and Methods
  4. Specialty Pharmacy Network
  5. Step-by-Step: Fastest Path to Approval
  6. Common Denial Reasons & Fixes
  7. Appeals Process in Virginia
  8. Support Lines and Contacts
  9. Virginia External Review Process
  10. FAQ

Verify Your Blue Cross Blue Shield Plan

Blue Cross Blue Shield in Virginia operates as Anthem Blue Cross Blue Shield (HealthKeepers, Inc.), serving about 43% of the commercial market. Your specific coverage depends on whether you have:

  • Commercial/Employer plan (most common)
  • ACA Marketplace plan
  • Medicaid managed care
  • Medicare Advantage
Tip: Check your member ID card for "Anthem" branding and visit anthem.com/va to confirm your drug formulary list.

Voxzogo requires prior authorization across all Anthem BCBS Virginia plans and must be dispensed through in-network specialty pharmacies.

Coverage at a Glance

Requirement What it means Where to find it Source
Prior Authorization PA required before coverage Availity Provider Portal Anthem VA Provider Manual
Specialty Pharmacy Must use network pharmacy Specialty Network List Anthem BCBS
Age Requirement FDA-approved ages 2+ with open epiphyses FDA label Voxzogo Prescribing Info
Specialist Required Pediatric endocrinologist/geneticist PA criteria Anthem UM protocols
Genetic Testing FGFR3 pathogenic variant confirmed PA documentation BioMarin PA Guide

Required Forms and Documentation

Core Documentation Checklist

Medical Records:

  • Genetic testing report confirming FGFR3 pathogenic variant
  • Bone age X-ray (within 12 months) showing open growth plates
  • 12+ months of height/weight measurements with growth velocity calculations
  • Complete medical history confirming achondroplasia diagnosis
  • Current specialist evaluation from pediatric endocrinologist or geneticist

Insurance Documentation:

  • Patient Enrollment Form (PEF) and Patient Caregiver Form (PCF) via BioMarin RareConnections
  • Insurance card front and back
  • Member ID and group number

Clinician Corner: Medical Necessity Letter

Your specialist's letter should include:

  • Problem: Achondroplasia with documented short stature and growth velocity concerns
  • Prior treatments: Document any previous growth-promoting interventions attempted
  • Clinical rationale: Reference FDA approval for achondroplasia in patients ≥2 years with open epiphyses
  • Dosing: Weight-based calculation (0.24 mg/kg subcutaneously once daily)
  • Monitoring plan: Regular growth assessments and safety monitoring per FDA label

Submission Portals and Methods

Primary Method: Availity Interactive Care Reviewer (ICR)

Best option for fastest processing:

  • Access via Availity.com or providers.anthem.com
  • Electronic submission with real-time status tracking
  • Upload clinical documentation directly
  • Automated eligibility verification

Alternative Submission Methods

Method Contact Timeline Notes
Fax 844-512-7022 5-10 business days Include cover sheet from Forms section
Expedited Fax 888-235-8390 72 hours For urgent cases only
Provider Phone 800-901-0020 Same day determination For HealthKeepers Plus members

Specialty Pharmacy Network

Voxzogo must be dispensed through Anthem's in-network specialty pharmacies:

Primary Network Options:

  • CVS Specialty (available for both pharmacy and medical benefit)
  • BioPlus Specialty Pharmacy
  • CenterWell Pharmacy
  • Noble Health Services Specialty Pharmacy
  • Transcript Pharmacy
Important: Using a non-network pharmacy will result in denial of coverage. Verify network status before prescribing.

Specialty Pharmacy Coordination

BioMarin RareConnections provides comprehensive support including:

  • Specialty pharmacy enrollment
  • Home delivery coordination
  • Refill reminders and adherence support
  • Insurance verification and reimbursement assistance

Step-by-Step: Fastest Path to Approval

Step 1: Enroll with BioMarin RareConnections

Who: Patient/caregiver
Timeline: 1-2 business days
Action: Complete enrollment at BioMarin RareConnections portal

Step 2: Gather Required Documentation

Who: Clinic staff
Timeline: 1-2 weeks
Action: Collect genetic testing, bone age X-ray, growth data, specialist evaluation

Step 3: Submit Prior Authorization

Who: Prescribing physician
Timeline: Same day submission
Action: Submit via Availity ICR with complete documentation

Step 4: Coordinate Specialty Pharmacy

Who: BioMarin RareConnections
Timeline: 2-3 business days after PA approval
Action: Enroll with approved network pharmacy for dispensing

Step 5: Monitor and Follow Up

Who: Clinic + patient
Timeline: Ongoing
Action: Track PA status in Availity; coordinate with specialty pharmacy for delivery

Common Denial Reasons & Fixes

Denial Reason How to Fix Required Documentation
Missing genetic confirmation Submit FGFR3 testing report Laboratory report confirming pathogenic variant
Growth plates not confirmed open Provide recent bone age X-ray Radiology report within 12 months
Insufficient growth data Submit comprehensive growth history 12+ months height/weight measurements
Non-specialist prescriber Transfer to pediatric endocrinologist/geneticist New prescription from qualified specialist
Age outside FDA approval Confirm patient age ≥2 years Birth certificate or medical record confirmation

Appeals Process in Virginia

Internal Appeals (Level 1)

Timeline: 30 days from denial notice
Method: Submit via Availity portal or fax
Required: Additional clinical documentation addressing denial reason

Internal Appeals (Level 2)

Timeline: 30 days from Level 1 denial
Method: Same as Level 1
Required: Peer-to-peer review option available

Expedited Appeals

Timeline: 72 hours for urgent cases
Method: Call provider services at 800-901-0020
Required: Physician certification of urgent medical need

Virginia External Review Process

If internal appeals fail, Virginia's Bureau of Insurance provides independent external review:

Filing Requirements

  • Timeline: Within 120 days of final internal denial
  • Form: Form 216-A External Review Request
  • Cost: No charge to patient
  • Contact: Virginia Bureau of Insurance at 1-877-310-6560

Review Process

  1. Preliminary review: Health carrier has 5 business days to verify eligibility
  2. IRO assignment: Bureau assigns independent review organization within 1 business day
  3. Additional documentation: 5 business days to submit supporting materials
  4. Decision: Independent review within 45 days (72 hours for expedited)
Note: The IRO decision is final and binding on both the insurer and patient.

When patients face coverage challenges, Counterforce Health specializes in turning insurance denials into targeted, evidence-backed appeals. The platform analyzes denial letters and plan policies to create point-by-point rebuttals aligned with the insurer's own criteria, incorporating FDA labeling, peer-reviewed studies, and specialty guidelines to support medical necessity arguments.

Support Lines and Contacts

For Patients

  • Anthem Member Services: Number on your ID card
  • BioMarin RareConnections: Available on Voxzogo support page
  • Virginia Managed Care Ombudsman: 1-877-310-6560

For Providers

FAQ

How long does BCBS Virginia PA take?
Standard PA decisions within 5-10 business days via Availity; expedited reviews within 72 hours for urgent cases.

What if Voxzogo is non-formulary on my plan?
Submit formulary exception request with medical necessity documentation; most specialty drugs require PA regardless of formulary status.

Can I request expedited appeal in Virginia?
Yes, if your physician certifies that standard timelines could seriously jeopardize health; expedited external reviews decided within 72 hours.

Does step therapy apply for achondroplasia?
Typically no, as Voxzogo is the only FDA-approved pharmacologic treatment for achondroplasia; document if other interventions were attempted.

What happens if I use an out-of-network pharmacy?
Coverage will be denied; Voxzogo must be dispensed through Anthem's specialty pharmacy network.

How much does Voxzogo cost without insurance?
List price approximately $320,000 annually before rebates; actual cost varies by weight and payer contracts.

Sources & Further Reading

Disclaimer: This information is for educational purposes only and does not constitute medical or legal advice. Coverage decisions depend on individual plan terms and medical circumstances. Always consult with your healthcare provider and insurance plan for specific coverage determinations. For personalized assistance with insurance appeals, consider consulting with healthcare coverage advocates like Counterforce Health, who specialize in evidence-based appeal strategies for specialty medications.

Powered by Counterforce Health—AI that turns drug denials into evidence-based appeals patients and clinicians can submit today.