Topic

Virginia

A collection of 470 issues

Myths vs. Facts: Getting Hemgenix (etranacogene dezaparvovec) Covered by Blue Cross Blue Shield in Virginia

Answer Box: Getting Hemgenix Covered in Virginia Blue Cross Blue Shield Virginia requires prior authorization for Hemgenix (etranacogene dezaparvovec) with strict eligibility criteria: adults 18+ with severe hemophilia B (≤2% Factor IX), current prophylaxis, documented bleeding history, and negative inhibitor tests. Success depends on complete documentation from a hematologist at

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

Quick Answer: Getting Onpattro (Patisiran) Covered by Aetna CVS Health in Virginia Aetna CVS Health covers Onpattro (patisiran) as a preferred specialty medication but requires prior authorization. To get approved: (1) Have your neurologist confirm hATTR polyneuropathy with genetic testing and document mNIS+7/6MWT scores, (2) Submit PA through

How to Get Tegsedi (Inotersen) Covered by Humana in Virginia: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Tegsedi (Inotersen) Covered by Humana in Virginia Tegsedi (inotersen) requires prior authorization from Humana Medicare Advantage and Part D plans. The fastest path to approval involves three key steps: (1) Ensure your prescriber enrolls in the FDA's Tegsedi REMS program and submits baseline lab results,

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

Quick Answer: Aetna CVS Health covers Tepezza for moderate-to-severe thyroid eye disease in Virginia with mandatory prior authorization requiring ophthalmologist evaluation, Clinical Activity Score ≥4, and documented steroid failure. Submit PA through CVS Specialty Pharmacy coordination. If denied, Virginia's Bureau of Insurance offers external review within 120 days

Myths vs. Facts: Getting Tysabri (Natalizumab) Covered by Aetna (CVS Health) in Virginia

Answer Box: Getting Tysabri Covered by Aetna (CVS Health) in Virginia Myth: If your doctor prescribes Tysabri, Aetna automatically covers it. Fact: Aetna requires prior authorization with TOUCH REMS enrollment, JCV antibody testing, baseline MRI, and documented step therapy failures for Crohn's disease. The fastest path to approval

How to Get Alecensa (alectinib) Covered by Cigna in Virginia: Complete Prior Authorization Guide with Appeals and Forms

Answer Box: Getting Alecensa (alectinib) Approved by Cigna in Virginia Cigna requires prior authorization for Alecensa (alectinib) in ALK-positive NSCLC, with 72-hour standard review and 24-hour expedited review. Submit via Cigna eviCore portal or Express Scripts with ALK test results, pathology report, and surgical documentation (for adjuvant use). If denied,

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

Answer Box: Getting Kymriah Covered by Cigna in Virginia Cigna requires prior authorization for Kymriah (tisagenlecleucel) via their Gene Therapy Program form. Submit through CoverMyMeds or call 855-678-0051. Standard review takes 15-30 business days; expedited takes 72 hours. If denied, Virginia offers internal appeals (180 days) then external review through

How Long Does It Take to Get Dupixent Approved by UnitedHealthcare in Virginia? Timeline & Appeal Guide

Answer Box: Getting Dupixent Approved by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for all Dupixent (dupilumab) prescriptions via OptumRx, with standard approvals taking 3-5 business days for complete submissions. In Virginia, your fastest path is: (1) Have your specialist submit a complete prior authorization package through the UnitedHealthcare provider

Work With Your Doctor to Get Nucala (Mepolizumab) Approved by UnitedHealthcare in Virginia: Complete Guide

Answer Box: Getting Nucala Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Nucala (mepolizumab) through OptumRx, with approval based on severe eosinophilic asthma criteria including blood eosinophil count ≥150 cells/μL and poor asthma control despite optimized therapy. Your fastest path: (1) Schedule a visit to document current

How to Get Xembify (Immune Globulin, SC) Covered by Humana in Virginia: Prior Authorization Guide and Appeal Process

Answer Box: Getting Xembify Covered by Humana in Virginia Yes, Xembify (immune globulin, SC) can be covered by Humana in Virginia, but requires prior authorization. Humana lists Xembify on their prior authorization requirements for Virginia plans under billing code J1558. Fastest path to approval: 1. Confirm primary immunodeficiency diagnosis with