Topic

Virginia

A collection of 392 issues

How to Get Kanuma (Sebelipase Alfa) Covered by Humana in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Kanuma Covered by Humana in Virginia Humana Medicare Advantage plans require prior authorization for Kanuma (sebelipase alfa) to treat LAL deficiency, with coverage requiring documented enzyme deficiency testing and clinical severity evidence. The fastest path: Have your prescriber submit a complete PA request through Humana's

How to Get Myalept (Metreleptin) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Myalept Covered by Aetna CVS Health in Virginia Myalept (metreleptin) requires prior authorization from Aetna CVS Health for generalized lipodystrophy (ICD-10 E88.12) only. The fastest path to approval: (1) Complete REMS certification at MyaleptREMS.com, (2) Submit PA with confirmed generalized lipodystrophy diagnosis, metabolic complications documentation,

How to Get Cosentyx (Secukinumab) Covered by Humana in Virginia: ICD-10 Codes, HCPCS Billing, and Appeals Guide

Answer Box: Getting Cosentyx (Secukinumab) Covered by Humana in Virginia Cosentyx (secukinumab) requires prior authorization from Humana with step therapy through preferred biologics first. The fastest path: your doctor submits a PA request via Humana's provider portal with proper ICD-10 codes (L40.0 for plaque psoriasis, L40.5x

How to Get Mepsevii (vestronidase alfa-vjbk) Covered by Cigna in Virginia: Timeline, Appeals, and Approval Forms

Quick Answer: Cigna requires prior authorization for Mepsevii (vestronidase alfa-vjbk) in Virginia, typically decided within 72 hours for standard requests and 24 hours for urgent cases. Submit via CoverMyMeds or your EHR's ePA system with complete MPS VII diagnosis documentation and specialist attestation. If denied, you have 180

Get Skyrizi (Risankizumab) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Skyrizi Covered by Aetna CVS Health in Virginia Aetna CVS Health requires prior authorization for Skyrizi (risankizumab) with step therapy mandates, typically requiring documented TNF inhibitor failure. Submit PA requests via Availity portal at least 2 weeks in advance. If denied, Virginia's State Corporation Commission

Get Turalio (Pexidartinib) Covered by Aetna CVS Health in Virginia: Decision Tree, Forms & Appeals Guide

Answer Box: Quick Eligibility Check To get Turalio (pexidartinib) covered by Aetna CVS Health in Virginia, you need: confirmed TGCT diagnosis with imaging, surgical consultation stating "severe morbidity" if resected, REMS program enrollment, and baseline liver function tests. Submit complete prior authorization through CVS Specialty (1-800-237-2767) with all

How to Get Kymriah (tisagenlecleucel) Covered by UnitedHealthcare in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Kymriah Covered by UnitedHealthcare in Virginia UnitedHealthcare covers Kymriah (tisagenlecleucel) under medical benefits as autologous stem cell therapy, requiring prior authorization through OptumHealth Transplant Solutions. For B-cell ALL (≤25 years) or relapsed/refractory DLBCL after ≥2 therapy lines, submit via the UHC Provider Portal with CD19+ confirmation,

Myths vs. Facts: Getting Tavneos (Avacopan) Covered by Cigna in Virginia

Answer Box: Fast Track to Tavneos Coverage Getting Tavneos (avacopan) covered by Cigna in Virginia requires prior authorization for severe active ANCA-associated vasculitis (GPA/MPA) prescribed by a specialist and used with standard therapy like rituximab or cyclophosphamide. Cigna typically reviews requests within 72 hours (24 hours expedited). If denied,

How to Get Revlimid (Lenalidomide) Covered by Blue Cross Blue Shield in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Revlimid Covered by Blue Cross Blue Shield in Virginia Blue Cross Blue Shield of Virginia requires prior authorization for Revlimid (lenalidomide), with approval depending on FDA-approved indications like multiple myeloma, documented prior treatment failures, and enrollment in the mandatory Lenalidomide REMS program. Your oncologist must submit clinical

How to Get Dupixent (dupilumab) Covered by Cigna in Virginia: Complete Decision Tree & Appeal Guide

Answer Box: Getting Dupixent Covered by Cigna in Virginia Fastest path: Check if you meet Cigna's prior authorization criteria for your specific condition (atopic dermatitis, asthma, COPD, or eosinophilic esophagitis), gather required documentation of failed prior therapies, and have your specialist submit a complete PA request. If denied,