Topic

Virginia

A collection of 238 issues

How to Get Tremfya (Guselkumab) Covered by Cigna in Virginia: PA Forms, Appeals, and Approval Timeline

Quick Answer: Getting Tremfya (Guselkumab) Covered by Cigna in Virginia Tremfya requires prior authorization from Cigna and is typically placed on Tier 5 (specialty) with step therapy requirements. To get coverage in Virginia: 1) Have your doctor submit the Cigna PA form with TB screening, PASI scores, and documented failure

How to Get Sylvant (Siltuximab) Covered by Humana in Virginia: Coding, Appeals, and State Review Process

Answer Box: Getting Sylvant Covered by Humana in Virginia Sylvant (siltuximab) requires prior authorization from Humana for idiopathic multicentric Castleman disease (iMCD). Use ICD-10 code D47.Z2 and HCPCS J-code J2860 (10 mg units). Submit PA requests through Humana's provider portal with HIV/HHV-8 negative test results and

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

Answer Box: Getting Orfadin Approved by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Orfadin (nitisinone) but does not require step therapy since it's the only FDA-approved treatment for hereditary tyrosinemia type 1 (HT-1). To get approval in Virginia: (1) Gather complete HT-1 diagnosis documentation including elevated succinylacetone

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Blue Cross Blue Shield in Virginia: Appeals, Forms & Timeline

Quick Answer: Your Path to Enhertu Coverage in Virginia Enhertu (fam-trastuzumab deruxtecan-nxki) requires prior authorization from Blue Cross Blue Shield Virginia, typically placed on specialty tier 4 formularies. Your oncologist must submit HER2 testing results, prior treatment documentation, and clinical justification. If denied, Virginia's external review process through

How to Get Humira (adalimumab) Covered by Aetna CVS Health in Virginia: Appeals Guide with Forms & Timelines

Quick Answer: To get Humira (adalimumab) covered by Aetna CVS Health in Virginia, you'll likely need prior authorization with documented step therapy failures. If denied, file an internal appeal within 60 days, request a peer-to-peer review, then pursue Virginia's external review process through the State Corporation

How to Get Strensiq (Asfotase Alfa) Covered by Humana in Virginia: PA Forms, Appeals, and Approval Strategy

Answer Box: Getting Strensiq Covered by Humana in Virginia Strensiq (asfotase alfa) requires prior authorization from Humana for pediatric-onset hypophosphatasia (HPP). The fastest path: 1) Confirm genetic testing shows pathogenic ALPL mutation, 2) Document persistently low age-adjusted alkaline phosphatase levels, 3) Submit PA request through Humana's provider portal

Get Crysvita (Burosumab) Covered by Cigna in Virginia: Complete Guide to Prior Authorization, Appeals, and State External Review

Answer Box: Getting Crysvita (Burosumab) Covered by Cigna in Virginia Cigna requires prior authorization for Crysvita (burosumab) with genetic confirmation of X-linked hypophosphatemia (XLH), clinical documentation, and serum phosphorus monitoring. The fastest path to approval involves three steps: (1) Complete genetic testing for XLH through the free Kyowa Kirin/Invitae

Get Alprolix Covered by Humana in Virginia: Complete Prior Authorization Guide with Appeals Process

Answer Box: Getting Alprolix Covered by Humana in Virginia Yes, Alprolix can be covered by Humana Medicare Advantage and commercial plans in Virginia, but requires prior authorization. The fastest path: Have your hematologist submit a PA request with detailed bleeding history, factor IX levels, and medical necessity documentation. Most Humana

Work With Your Doctor to Get Dojolvi (Triheptanoin) Approved by Blue Cross Blue Shield in Virginia: Complete PA and Appeals Guide

Quick Answer: Getting Dojolvi Approved by Blue Cross Blue Shield in Virginia Blue Cross Blue Shield requires strict prior authorization for Dojolvi (triheptanoin), mandating molecular confirmation of LC-FAOD, specialist supervision, and detailed clinical documentation. Your fastest path to approval: 1) Confirm genetic testing proves LC-FAOD, 2) Work with a metabolic

How to Get Elaprase (idursulfase) Covered by Blue Cross Blue Shield in Virginia: Complete Appeals Guide

Answer Box: Getting Elaprase Covered by Blue Cross Blue Shield in Virginia Blue Cross Blue Shield Virginia requires prior authorization for Elaprase (idursulfase) based on confirmed Hunter syndrome diagnosis and weight-based dosing calculations. The fastest path to approval: (1) Submit enzymatic and genetic test results confirming MPS II, (2) Include