Topic

Elevidys (delandistrogene moxeparvovec-rokl)

A collection of 38 issues

How to Get Elevidys Covered by UnitedHealthcare in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Get Elevidys Covered by UnitedHealthcare in Ohio Elevidys (delandistrogene moxeparvovec-rokl) requires prior authorization from UnitedHealthcare OptumRx for DMD patients in Ohio. Key steps: 1) Submit PA with genetic confirmation, failed corticosteroid documentation, and anti-AAV antibody titers <1:400, 2) If denied, file internal appeal within 180 days,

How to Get Elevidys Covered by Blue Cross Blue Shield in New York: Prior Authorization, Appeals, and Renewal Guide

Answer Box: Getting Elevidys Covered by Blue Cross Blue Shield in New York Fastest path: Contact your neurologist to submit a prior authorization through your specific BCBS plan's provider portal (Empire, Highmark, or Excellus). Include genetic testing confirming DMD, current ambulatory status, age ≥4 years, baseline liver function

How to Get Elevidys Covered by Blue Cross Blue Shield in Pennsylvania: Prior Authorization Guide with Appeals Process

Answer Box: To get Elevidys covered by Blue Cross Blue Shield in Pennsylvania, you need: 1) Confirmed DMD genetic testing showing pathogenic mutation, 2) Age ≥4 years with negative anti-AAVrh74 antibodies, 3) Prior authorization through your BCBS plan's electronic portal (Availity for Highmark, IBX portal for Independence). Most

Aetna's Coverage Criteria for Elevidys in Florida: What Counts as "Medically Necessary"?

Answer Box: Getting Elevidys Covered by Aetna in Florida Aetna requires prior authorization for Elevidys (delandistrogene moxeparvovec-rokl) with strict medical necessity criteria: confirmed DMD diagnosis with pathogenic gene mutation (excluding exons 8-9 deletions), ambulatory status, age ≥4 years, acceptable anti-AAVrh74 antibody levels, and comprehensive hepatic monitoring plan. Submit PA through

Myths vs. Facts: Getting Elevidys (delandistrogene moxeparvovec-rokl) Covered by Aetna (CVS Health) in Michigan

Answer Box: Getting Elevidys Covered by Aetna (CVS Health) in Michigan Eligibility: Aetna covers Elevidys for ambulatory DMD patients aged 4+ with confirmed genetic mutation, anti-AAVrh74 antibodies <1:400, and treatment at designated centers. Fastest path: Submit prior authorization 2-3 weeks before treatment with genetic testing, antibody results, and

Myths vs. Facts: Getting Elevidys (Delandistrogene Moxeparvovec-rokl) Covered by Cigna in Virginia – Appeals Guide

Answer Box: Getting Elevidys Covered by Cigna in Virginia Fastest Path: 1) Confirm your child meets FDA criteria (ambulatory DMD with eligible mutation, anti-AAV antibodies <1:400). 2) Have your neuromuscular specialist submit prior authorization via ExpressPAth with complete genetic testing, functional assessments, and center-of-excellence documentation. 3) If denied,

How to Get Elevidys Covered by Humana in Illinois: Complete PA Guide and Appeal Forms

Answer Box: Getting Elevidys Covered by Humana in Illinois Elevidys requires prior authorization from Humana and must be administered at certified centers like Lurie Children's Hospital in Chicago. The fastest path: 1) Confirm DMD genetic testing and anti-AAV antibody levels meet criteria, 2) Submit PA through Humana'

Blue Cross Blue Shield Georgia's Coverage Criteria for Elevidys: What Counts as "Medically Necessary" for DMD Gene Therapy

Answer Box: Getting Elevidys Covered by Blue Cross Blue Shield Georgia Elevidys requires prior authorization from Blue Cross Blue Shield Georgia with strict medical necessity criteria: confirmed DMD genetic mutation (excluding deletions in exons 8/9), age 4-5 years, ambulatory status, anti-AAVrh74 antibody titer <1:400, and treatment at

Do You Qualify for Elevidys Coverage by Cigna in Michigan? Complete Decision Tree & Appeal Guide

Quick Answer: Cigna requires prior authorization for Elevidys (delandistrogene moxeparvovec-rokl) with strict DMD genetic testing, anti-AAVrh74 antibody screening, and steroid protocol documentation. Most eligible patients need complete medical records, specialist letter, and submission through Cigna's specialty pharmacy network. If denied, Michigan patients have 180 days for internal appeals,

How Long Does It Take to Get Elevidys Approved by Cigna in Texas? Complete Timeline & Requirements

Answer Box: Getting Elevidys Approved by Cigna in Texas Timeline: 5-15 business days for standard prior authorization once complete documentation is submitted. Expedited reviews take 72 hours for urgent cases. Fastest path to approval: 1. Confirm genetic DMD diagnosis and anti-AAVrh74 antibody titer ≤1:400 2. Submit complete PA request