Topic

Virginia

A collection of 393 issues

How to Get Takhzyro (lanadelumab-flyo) Covered by Aetna CVS Health in Virginia: Complete Guide to Forms, Appeals, and Approval

Quick Answer: Getting Takhzyro Covered by Aetna CVS Health in Virginia Eligibility: Aetna CVS Health requires prior authorization for Takhzyro (lanadelumab-flyo) with confirmed HAE Type 1 or 2 diagnosis, documented attack history (≥1 attack per 4 weeks), and specialist prescription. Fastest approval path: Submit complete PA packet with C1-INH lab

Do You Qualify for Tracleer (bosentan) Coverage by UnitedHealthcare in Virginia? Decision Tree & Next Steps

Answer Box: Your Path to Tracleer Coverage in Virginia Eligibility: Tracleer requires UnitedHealthcare prior authorization for WHO Group 1 PAH with specialist prescription and REMS enrollment. Fastest approval path: Ensure right heart catheterization confirms PAH diagnosis (mPAP >20 mmHg, PAWP ≤15 mmHg, PVR >2 Wood units), complete REMS

How to Get Opsumit (macitentan) Covered by Blue Cross Blue Shield in Virginia: Complete PA Guide & Appeals Process

Answer Box: Getting Opsumit (macitentan) Covered by Blue Cross Blue Shield in Virginia Fastest Path: Opsumit requires prior authorization from Blue Cross Blue Shield in Virginia. Your pulmonologist must submit PA documentation including WHO Group 1 PAH diagnosis, step therapy compliance, and pregnancy testing records. If denied, Virginia offers external

Getting Hemgenix (etranacogene dezaparvovec) Approved by UnitedHealthcare in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: How to Get Hemgenix Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Hemgenix (etranacogene dezaparvovec) with strict clinical criteria: 50+ Factor IX exposure days, no inhibitors, adult status, and normal liver function. Step 1: Submit PA through the UnitedHealthcare Provider Portal with comprehensive documentation from a

If Abecma Isn't Approved by Blue Cross Blue Shield in Virginia: Formulary Alternatives & Exception Paths

Answer Box: Your Options When BCBS Virginia Denies Abecma If Blue Cross Blue Shield Virginia denies Abecma (idecabtagene vicleucel), Carvykti (ciltacabtagene autoleucel) is the primary formulary alternative CAR-T therapy for multiple myeloma. Both require prior authorization and similar clinical criteria. First step today: Contact your oncologist to discuss switching to

How to Get Prolastin-C Covered by Aetna CVS Health in Virginia: Appeal Process, Forms & Timelines

Answer Box: Getting Prolastin-C Covered by Aetna CVS Health in Virginia Prolastin-C is non-formulary for most Aetna commercial plans but may be covered for Medicare members with prior authorization. Your fastest path: 1) Check if you qualify for preferred alternatives (Aralast NP, Glassia), 2) Submit a formulary exception request with

How to Get Exondys 51 (Eteplirsen) Covered by Blue Cross Blue Shield in Virginia: Complete PA Guide with Appeal Forms and Timelines

Answer Box: Getting Exondys 51 Covered in Virginia Exondys 51 (eteplirsen) is covered by Blue Cross Blue Shield Virginia as a specialty pharmacy benefit but requires prior authorization with genetic confirmation of an exon 51-amenable DMD mutation. Your fastest path: 1) Confirm genetic testing shows exon 51 skipping eligibility, 2)

How to Get Kanuma (sebelipase alfa) Covered by Aetna (CVS Health) in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Kanuma Covered by Aetna (CVS Health) in Virginia Kanuma (sebelipase alfa) requires prior authorization from Aetna (CVS Health) in Virginia. Your fastest path to approval: 1) Gather LAL enzyme activity results (<10% normal) and LIPA gene testing confirming pathogenic variants, 2) Submit Aetna's Kanuma-specific

How to Renew Alecensa (alectinib) Coverage with Humana in Virginia: Timeline, Documentation, and Appeals Process

Answer Box: Renewing Alecensa (alectinib) with Humana in Virginia Renewal timing: Start 30-60 days before your current authorization expires. Required documents: Updated oncologist letter showing stable disease/response, recent imaging, liver function tests, and continued ALK-positive status confirmation. Timeline: Humana provides decisions within 72 hours (24 hours if expedited). First

Blue Cross Blue Shield Virginia's Coverage Criteria for Darzalex/Darzalex Faspro: What Counts as "Medically Necessary"?

Answer Box: Getting Darzalex Covered by Blue Cross Blue Shield in Virginia Blue Cross Blue Shield Virginia requires prior authorization for daratumumab (Darzalex/Darzalex Faspro) with specific medical necessity criteria. To get approved: (1) Have your oncologist document FDA-approved diagnosis (multiple myeloma or AL amyloidosis) with ICD-10 codes, (2) Submit