Topic

Virginia

A collection of 47 issues

Renewing Brineura (Cerliponase Alfa) Approval with Cigna in Virginia: 2025 Guide to Documentation, Timelines, and Appeals

Answer Box: Renewing Your Brineura Coverage with Cigna in Virginia Cigna typically authorizes Brineura (cerliponase alfa) for 6-month periods and requires comprehensive renewal documentation including updated clinical notes, device status reports, and evidence of ongoing benefit. Start your renewal application 30-60 days before expiration to avoid therapy gaps. Required documents

How to Renew Ocrevus (Ocrelizumab) Coverage with Aetna CVS Health in Virginia: Timeline, Forms & Bridge Options

Answer Box: Renewing Ocrevus Coverage with Aetna CVS Health in Virginia To renew Ocrevus (ocrelizumab) with Aetna CVS Health in Virginia, submit your renewal request at least 2 weeks before your next scheduled infusion. You'll need updated clinical documentation showing disease stability or improvement, neurologist attestation, and confirmation

How to Get Cabometyx (Cabozantinib) Covered by Cigna in Virginia: Complete Guide to Prior Authorization, Appeals, and State Protections

Quick Answer: To get Cabometyx (cabozantinib) covered by Cigna in Virginia, your doctor must submit a prior authorization through CoverMyMeds or ExpressPAth within 72 hours for standard review (24 hours if expedited). If denied, file an internal appeal within 180 days, then request external review through Virginia's Bureau

How to Get Xenpozyme (olipudase alfa-rpcp) Covered by Blue Cross Blue Shield in Virginia: Complete Timeline & Appeal Guide

Quick Answer: Getting Xenpozyme Covered by Blue Cross Blue Shield in Virginia Xenpozyme (olipudase alfa-rpcp) requires prior authorization from Blue Cross Blue Shield Virginia, typically decided within 72 hours for standard requests. To get approved: (1) Ensure you have documented ASMD diagnosis with genetic/enzyme confirmation, (2) Submit complete prior

Xospata (Gilteritinib) Approval with UnitedHealthcare in Virginia: Answers to the Most Common Questions

Answer Box: Getting Xospata Covered by UnitedHealthcare in Virginia Xospata (gilteritinib) requires prior authorization from UnitedHealthcare for relapsed/refractory AML with confirmed FLT3 mutations. Fastest approval path: Submit PA with FDA-approved FLT3 test results, prior therapy documentation, and oncologist's medical necessity letter. First step today: Have your hematologist/

How to Get Jynarque (Tolvaptan) Covered by Cigna in Virginia: Complete PA Guide and Appeals Process

Quick Answer: Getting Jynarque Covered by Cigna in Virginia Fastest path to approval: Your nephrologist must document ADPKD with rapid progression (Mayo Class 1C-1E or eGFR decline ≥3.0 mL/min/1.73 m²/year), baseline eGFR ≥25, and complete REMS enrollment before submitting Cigna's prior authorization form.

Getting Prolastin-C Covered by Blue Cross Blue Shield in Virginia: Complete Guide to Prior Authorization, Appeals, and State External Review

Answer Box: Prolastin-C Coverage with Blue Cross Blue Shield in Virginia Blue Cross Blue Shield Virginia requires prior authorization for Prolastin-C (alpha1-proteinase inhibitor) for alpha-1 antitrypsin deficiency. Coverage requires documented severe AATD (like Pi*ZZ genotype), clinical evidence of emphysema, and lung function tests showing moderate impairment (typically FEV1 35-60%

How to Get Kineret (anakinra) Covered by UnitedHealthcare in Virginia: Complete Appeals Guide with Forms and Templates

Answer Box: Getting Kineret Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Kineret (anakinra) with step therapy requirements. For rheumatoid arthritis, you must have failed at least one DMARD like methotrexate. If denied, you have 180 days for internal appeals and 120 days for Virginia's external

Get Photrexa (Riboflavin) Covered by Humana in Virginia: Prior Authorization Guide

Quick Answer: Getting Photrexa Covered by Humana in Virginia Humana requires prior authorization for Photrexa (riboflavin) corneal crosslinking procedures. Your ophthalmologist must submit documentation proving progressive keratoconus with objective measurements (Kmax increase ≥1.0 diopter, pachymetry decrease ≥15 microns over 12 months). If denied, Virginia's Bureau of Insurance

How to Get Gamifant (Emapalumab-lzsg) Covered by Humana in Virginia: Complete Guide with Forms and Appeal Process

Quick Answer: Getting Gamifant (Emapalumab-lzsg) Covered by Humana in Virginia Fastest path to approval: Have your hematologist submit a prior authorization request to Humana with documented HLH-2004 criteria (5 of 8 required), genetic testing or family history, and evidence of conventional therapy failure. Submit via fax to 502-508-9300 with complete