Topic

Strimvelis (autologous CD34+ ADA-SCID gene therapy)

A collection of 32 issues

How to Get Strimvelis Gene Therapy Covered by Humana in Michigan: Coding, Appeals, and Authorization Guide

Answer Box: Getting Strimvelis Covered by Humana in Michigan Strimvelis requires prior authorization from Humana using ICD-10 code D81.1 (ADA-deficient SCID) and unclassified HCPCS codes C9399 or J3590 since it lacks a specific J-code. Submit PA requests to Humana National Transplant Network at 866-421-5663 or fax 502-508-9300. If denied,

How to Get Strimvelis Gene Therapy Covered by Aetna CVS Health in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Get Strimvelis Covered by Aetna CVS Health in Illinois Strimvelis gene therapy for ADA-SCID requires prior authorization from Aetna CVS Health with genetic confirmation of biallelic ADA mutations, enzyme activity <1% normal, and documented failures of PEG-ADA therapy. Submit through the Aetna provider portal with a medical

How to Get Strimvelis Gene Therapy Covered by Blue Cross Blue Shield in Illinois: Complete Guide to International Treatment Authorization and Appeals

Answer Box: Getting Strimvelis Covered in Illinois Strimvelis gene therapy for ADA-SCID requires special authorization from Blue Cross Blue Shield of Illinois (BCBSIL) as an experimental/international treatment. Start by calling BCBSIL member services at 1-800-892-2803 to verify international coverage benefits and request experimental treatment exception forms. Submit comprehensive medical

The Requirements Checklist to Get Strimvelis Gene Therapy Covered by Cigna in Michigan: Forms, Appeals, and Milan Treatment Guide

Answer Box: Getting Strimvelis Covered by Cigna in Michigan Strimvelis requires prior authorization through Cigna's Express Scripts specialty pharmacy division using their Non-Specific Gene Therapy form. Key requirements: confirmed ADA-SCID diagnosis with bi-allelic ADA gene mutations, documented absence of HLA-matched related donor, and failed/contraindicated PEG-ADA enzyme replacement

How Long Does It Take to Get Strimvelis Gene Therapy Approved by Blue Cross Blue Shield in Virginia? Complete Timeline and Appeals Guide

Answer Box: Getting Strimvelis Covered by Blue Cross Blue Shield in Virginia Strimvelis gene therapy requires prior authorization from Blue Cross Blue Shield (BCBS) in Virginia, with no specific coverage policy for this EU-approved ADA-SCID treatment. Approval depends on demonstrating medical necessity through genetic testing, failed standard treatments, and international

The Requirements Checklist to Get Strimvelis (Autologous CD34+ ADA-SCID Gene Therapy) Covered by Blue Cross Blue Shield in Pennsylvania

Answer Box: Fast Track to Approval Getting Strimvelis (autologous CD34+ ADA-SCID gene therapy) covered by Blue Cross Blue Shield in Pennsylvania requires prior authorization via medical exception due to non-FDA approval and international treatment location (SR-TIGET, Milan). Success depends on: (1) confirmed ADA-SCID diagnosis with biallelic ADA mutations and enzyme

Getting Strimvelis Gene Therapy Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Strimvelis Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Strimvelis (autologous CD34+ ADA-SCID gene therapy) as a non-formulary, international specialty treatment. Start by confirming your ADA-SCID diagnosis with genetic testing, documenting failed or contraindicated alternatives, and submitting through the UHC Provider Portal. If denied,

How to Get Strimvelis Gene Therapy Covered by Humana in New York: Appeals Process and External Review Guide

Answer Box: Getting Strimvelis Covered by Humana in New York Strimvelis (autologous CD34+ ADA-SCID gene therapy) is not FDA-approved and only available at SR-TIGET in Milan, Italy. Humana Medicare Advantage plans typically deny coverage for non-emergency international treatments. Your path to approval: 1) Submit comprehensive prior authorization with genetic testing,

Get Strimvelis Gene Therapy Covered by UnitedHealthcare in Ohio: Complete Prior Authorization and Appeals Guide 2025

Quick Answer: Getting Strimvelis Covered in Ohio Strimvelis requires comprehensive prior authorization from UnitedHealthcare due to its status as a non-FDA approved gene therapy only available in Milan, Italy. In Ohio, you'll need: (1) confirmed ADA-SCID diagnosis with genetic testing, (2) documentation that standard treatments (HSCT, enzyme replacement)

How to Get Strimvelis Gene Therapy Covered by UnitedHealthcare in Illinois: Complete PA Guide and Appeals Process

Answer Box: Getting Strimvelis Covered by UnitedHealthcare in Illinois Strimvelis requires prior authorization from UnitedHealthcare and faces significant coverage challenges since it's only available in Milan, Italy, and lacks FDA approval in the U.S. Your fastest path: (1) Have your immunologist submit PA with confirmed ADA-SCID diagnosis