Topic

Virginia

A collection of 471 issues

Renewing Raxone (Idebenone) Approval with Cigna in Virginia: Timeline, Documentation, and Coverage Lapse Solutions

Answer Box: Renewing Your Raxone (Idebenone) Approval Cigna requires annual prior authorization renewals for Raxone (idebenone) through Express Scripts/Accredo, typically 30-60 days before current approval expires. Submit renewal via CoverMyMeds, Evicore ePA, or MyAccredoPatients with updated clinical documentation proving ongoing LHON progression, visual response monitoring, and adherence. If coverage

Do You Qualify for Strensiq (asfotase alfa) Coverage by Cigna in Virginia? Decision Tree & Next Steps

Answer Box: Your Path to Strensiq Coverage in Virginia Yes, Cigna covers Strensiq (asfotase alfa) for perinatal/infantile- and juvenile-onset hypophosphatasia when criteria are met. To qualify, you need confirmed HPP diagnosis (low ALP + ALPL gene mutation OR elevated substrates), pediatric-onset symptoms, and specialist involvement. Start today: Contact your endocrinologist/

Oxbryta (Voxelotor) Coverage Denial by Humana in Virginia: Understanding FDA Withdrawal and Alternative Treatment Appeals

Answer Box: Oxbryta Coverage Status in Virginia Oxbryta (voxelotor) is no longer available in the United States as of September 2024 due to FDA withdrawal following safety concerns. Humana and all insurers now automatically deny coverage because the drug lost FDA approval. If you're currently on Oxbryta or

How to Get Koselugo (selumetinib) Covered by Humana in Virginia: Complete Timeline and Appeals Guide

Answer Box: Fast Track to Koselugo Coverage Koselugo (selumetinib) requires prior authorization from Humana for pediatric patients (≥2 years) with NF1 and symptomatic, inoperable plexiform neurofibromas. Standard decisions take 72 hours; expedited requests take 24 hours if life/health is at risk. Submit via CoverMyMeds or Humana's provider

How to Get Cystadane (Betaine Anhydrous) Covered by Aetna CVS Health in Virginia: Prior Authorization Guide and Appeals Process

Answer Box: Getting Cystadane (Betaine Anhydrous) Covered by Aetna CVS Health in Virginia Cystadane (betaine anhydrous) requires prior authorization from Aetna CVS Health in Virginia. Submit genetic testing confirmation of homocystinuria, current homocysteine/methionine lab values, and documentation of vitamin therapy trials (B6, B12, folate) via Availity portal for fastest

How to Get Soliris (Eculizumab) Covered by UnitedHealthcare in Virginia: Complete Forms, Appeals, and Contact Guide

Answer Box: Getting Soliris (Eculizumab) Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Soliris (eculizumab) under the medical benefit (HCPCS J1299) with diagnosis-specific criteria including lab confirmation, failed prior therapies, and REMS compliance. Submit PA via UnitedHealthcare provider portal or fax to 1-844-403-1028. If denied, you have 180

How to Get Vitrakvi (larotrectinib) Covered by UnitedHealthcare in Virginia: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Vitrakvi Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Vitrakvi (larotrectinib) with specific criteria: confirmed NTRK gene fusion via validated testing, metastatic or unresectable solid tumor, and no known resistance mutations. Submit through OptumRx portal with molecular pathology report, staging documentation, and oncologist notes. Decisions

How to Get Rinvoq (upadacitinib) Covered by Aetna (CVS Health) in Virginia: Complete Guide with Forms, Timelines, and Appeal Scripts

Answer Box: Fastest Path to Rinvoq (upadacitinib) Coverage Aetna (CVS Health) requires prior authorization for Rinvoq (upadacitinib) in Virginia, mandating documented failure or intolerance to at least one TNF inhibitor. Submit your PA request via Aetna's provider portal or CoverMyMeds with complete clinical documentation including prior therapy records,

How to Get Tavalisse (fostamatinib) Covered by Blue Cross Blue Shield in Virginia: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Tavalisse Covered by Blue Cross Blue Shield in Virginia Tavalisse (fostamatinib) requires prior authorization from Blue Cross Blue Shield Virginia and typically needs documented failure of first-line treatments (corticosteroids, IVIG) and TPO receptor agonists (eltrombopag/Promacta, romiplostim/Nplate) for chronic ITP. Submit PA through your hematologist with

How to Get Kuvan (Sapropterin) Approved by UnitedHealthcare in Virginia: Complete Prior Authorization Guide

Quick Answer: Getting Kuvan Approved by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Kuvan (sapropterin) through OptumRx, typically approving within 24-72 hours when you submit complete documentation. You'll need: confirmed PKU diagnosis (ICD-10 E70.0), recent phenylalanine levels, proof of phenylalanine-restricted diet, and metabolic specialist prescription. Submit