Topic

Virginia

A collection of 471 issues

If Uplizna (Inebilizumab) Isn't Approved by Cigna in Virginia: Formulary Alternatives & Exception Paths

Answer Box: When Cigna Denies Uplizna (Inebilizumab) in Virginia If Cigna denies Uplizna (inebilizumab) for NMOSD or IgG4-related disease in Virginia, you have three main paths: (1) try formulary alternatives like Enspryng or Soliris first (step therapy), (2) request a formulary exception with medical necessity documentation, or (3) appeal through

Aetna (CVS Health)'s Coverage Criteria for Revlimid (Lenalidomide) in Virginia: What Counts as "Medically Necessary"?

Answer Box: Getting Revlimid (Lenalidomide) Covered by Aetna (CVS Health) in Virginia Aetna (CVS Health) covers Revlimid (lenalidomide) with prior authorization when medically necessary for FDA-approved indications like multiple myeloma and certain lymphomas. To qualify: (1) Submit PA with diagnosis confirmation, prior therapy history, and REMS enrollment proof; (2) Include

How to Get Amondys 45 (Casimersen) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Amondys 45 Covered by Aetna CVS Health in Virginia Aetna CVS Health requires prior authorization for Amondys 45 (casimersen) with strict genetic testing and functional requirements. To get approval in Virginia: (1) Submit Aetna's dedicated precertification form with genetic proof of exon 45-amenable DMD mutation,

Getting Hetlioz LQ Covered by Cigna in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Hetlioz LQ Covered by Cigna in Virginia Cigna requires prior authorization for Hetlioz LQ (tasimelteon oral suspension) for Smith-Magenis Syndrome sleep disturbance in children 3-15 years. Virginia law provides strong protections including step therapy medical exceptions, 72-hour PA decisions, and binding external review through the State Corporation

How Long Does It Take to Get Duopa (Carbidopa/Levodopa Enteral) Approved by UnitedHealthcare in Virginia? Complete Timeline & Appeals Guide

Answer Box: Getting Duopa Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization (PA) for Duopa (carbidopa/levodopa enteral) with 15-day standard review or 72-hour expedited review for urgent cases. Success requires documenting advanced Parkinson's disease, failed oral therapy, and planned PEG-J tube placement. First step: Have your

How Long Does It Take to Get Somatuline Depot (lanreotide) Approved by Blue Cross Blue Shield in Virginia? Complete Timeline & Appeals Guide

Answer Box: Getting Somatuline Depot (lanreotide) approved by Blue Cross Blue Shield in Virginia typically takes 5-10 business days for standard prior authorization, or 72 hours for expedited cases. Your fastest path: Have your endocrinologist/oncologist submit complete documentation including diagnosis confirmation, prior octreotide trial details, and medical necessity justification

How Long Does It Take to Get Strimvelis Gene Therapy Approved by Blue Cross Blue Shield in Virginia? Complete Timeline and Appeals Guide

Answer Box: Getting Strimvelis Covered by Blue Cross Blue Shield in Virginia Strimvelis gene therapy requires prior authorization from Blue Cross Blue Shield (BCBS) in Virginia, with no specific coverage policy for this EU-approved ADA-SCID treatment. Approval depends on demonstrating medical necessity through genetic testing, failed standard treatments, and international

How to Get Opdivo (nivolumab) Covered by UnitedHealthcare in Virginia: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Opdivo (nivolumab) Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Opdivo (nivolumab) in Virginia, with approval based on FDA-labeled indications, biomarker testing, and documented treatment failures. The fastest path: Submit a complete PA through the UHC Provider Portal with diagnosis, staging, biomarkers (PD-L1, MSI-H/dMMR

How to Get Orkambi (lumacaftor/ivacaftor) Covered by Blue Cross Blue Shield in Virginia: PA Forms, Appeal Scripts & State Protections

Answer Box: Getting Orkambi Covered by Blue Cross Blue Shield in Virginia Blue Cross Blue Shield (Anthem) in Virginia requires prior authorization for Orkambi (lumacaftor/ivacaftor) with genetic testing proving F508del mutations and age ≥2 years. Virginia's step therapy laws protect CF patients with documented contraindications or prior

How to Get Oxlumo (Lumasiran) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization Guide

Answer Box: Getting Oxlumo (Lumasiran) Approved by Aetna CVS Health in Virginia Aetna CVS Health requires prior authorization for Oxlumo (lumasiran) in Virginia with genetic confirmation of PH1, baseline urinary oxalate levels, and specialist prescriber. Submit the Aetna Oxlumo Precertification Request Form with AGXT testing and labs. Standard approval takes