Topic

Virginia

A collection of 392 issues

Myths vs. Facts: Getting Amondys 45 (casimersen) Covered by UnitedHealthcare in Virginia – Complete Prior Authorization Guide

Answer Box: Getting Amondys 45 (casimersen) Covered by UnitedHealthcare in Virginia Quick Facts: UnitedHealthcare requires prior authorization for Amondys 45 (casimersen) under their medical benefit drug policy. Success depends on genetic proof of exon 45 mutation, ambulatory status documentation, and specialist involvement. First step today: Verify your plan type (commercial

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

Answer Box: Your Fast Track to Tecentriq Coverage Getting Tecentriq (atezolizumab) covered by Aetna CVS Health in Virginia requires prior authorization with specific biomarker testing. Submit Aetna's Tecentriq precertification form with PD-L1 test results (≥1% for adjuvant NSCLC, ≥50% for first-line metastatic), negative EGFR/ALK mutation testing, and

Oxbryta (Voxelotor) Coverage with UnitedHealthcare in Virginia: FDA Withdrawal Impact and Alternative Options

Answer Box: Oxbryta Coverage Status with UnitedHealthcare in Virginia Important: Oxbryta (voxelotor) was voluntarily withdrawn from the U.S. market by Pfizer in September 2024 following FDA review. UnitedHealthcare now typically denies claims due to loss of FDA approval. If you're currently taking Oxbryta, work with your hematologist

How to Get Lutathera (lutetium Lu-177 dotatate) Covered by Cigna in Virginia: PA Requirements, Appeals, and Success Strategies

Answer Box: Your Fastest Path to Coverage To get Lutathera (lutetium Lu-177 dotatate) covered by Cigna in Virginia: Submit prior authorization with somatostatin receptor-positive imaging, documented progression on somatostatin analogs, and nuclear medicine facility credentials. If denied, file internal appeal within 180 days, then Virginia external review using Form 216-A

How to Get Myalept (Metreleptin) Covered by Blue Cross Blue Shield in Virginia: Complete PA Guide and Appeal Process

Answer Box: Getting Myalept Covered in Virginia Fast Track to Approval: Myalept (metreleptin) coverage through Blue Cross Blue Shield in Virginia requires confirmed generalized lipodystrophy diagnosis, REMS program enrollment, and comprehensive prior authorization. Start today by: (1) Ensuring your endocrinologist is REMS-certified, (2) gathering leptin levels and body fat imaging,

How to Get Hemlibra (emicizumab-kxwh) Covered by Cigna in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: To get Hemlibra (emicizumab-kxwh) covered by Cigna in Virginia, you need prior authorization with hemophilia A diagnosis, factor VIII inhibitor testing, and bleeding history documentation. Submit through CoverMyMeds or fax to (855) 840-1678. Standard review takes 15-30 days. If denied, file internal appeal within 180 days, then Virginia

Getting Pombiliti (Cipaglucosidase Alfa-atga) Covered by UnitedHealthcare in Virginia: Complete Appeals Guide

Quick Answer: Your Path to Pombiliti Coverage in Virginia If UnitedHealthcare denied your Pombiliti (cipaglucosidase alfa-atga) prescription, you have strong appeal rights in Virginia. First step: Request a peer-to-peer review within 24 hours of denial. Second step: File an internal appeal within 180 days. Final step: Submit Form 216-A to

How to Get Zanzalintinib (XL092) Covered by Blue Cross Blue Shield in Virginia: Clinical Trial Access and Compassionate Use Guide

Answer Box: Getting Zanzalintinib (XL092) Coverage in Virginia Zanzalintinib (XL092) is not FDA-approved and typically isn't covered by Blue Cross Blue Shield Virginia outside clinical trials. Your fastest path: 1) Check ClinicalTrials.gov for ongoing STELLAR program studies, 2) Contact Exelixis directly about compassionate use programs, and 3)

The Complete Requirements Checklist to Get Strensiq (Asfotase Alfa) Covered by Blue Cross Blue Shield in Virginia

Answer Box: Your Path to Strensiq Coverage in Virginia Getting Strensiq (asfotase alfa) covered by Blue Cross Blue Shield in Virginia requires prior authorization with genetic or biochemical confirmation of pediatric-onset hypophosphatasia. The fastest path: have your doctor submit genetic testing (ALPL mutation) or low alkaline phosphatase levels plus elevated

How to Get Elelyso (Taliglucerase Alfa) Covered by Humana in Virginia: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Elelyso (Taliglucerase Alfa) Covered by Humana in Virginia Fastest path to approval: Have your specialist submit a prior authorization request with confirmed Gaucher disease Type 1 diagnosis (enzyme assay or genetic testing), clinical evidence of disease manifestations, and medical necessity documentation. If denied, you have 65 days