Topic

Virginia

A collection of 394 issues

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
6 min read

Myths vs. Facts: Getting Elevidys (Delandistrogene Moxeparvovec-rokl) Covered by Cigna in Virginia – Appeals Guide

Answer Box: Getting Elevidys Covered by Cigna in Virginia Fastest Path: 1) Confirm your child meets FDA criteria (ambulatory DMD with eligible mutation, anti-AAV antibodies <1:400). 2) Have your neuromuscular specialist submit prior authorization via ExpressPAth with complete genetic testing, functional assessments, and center-of-excellence documentation. 3) If denied,
6 min read

Do You Qualify for Entresto (sacubitril/valsartan) Coverage by Humana in Virginia? Complete Decision Tree & Appeals Guide

Answer Box: Getting Entresto Covered by Humana in Virginia Eligibility: You likely qualify if you have chronic heart failure with LVEF ≤40%, documented ACE inhibitor/ARB trial or intolerance, and NYHA Class II-IV symptoms. Fastest path: Submit prior authorization with recent echocardiogram, medication history, and cardiologist letter via Humana portal.
6 min read

Myths vs. Facts: Getting Stelara (ustekinumab) Covered by Blue Cross Blue Shield in Virginia - Appeals Guide 2025

Answer Box: Getting Stelara Covered by BCBS Virginia Eligibility: BCBS Virginia (Anthem) requires prior authorization for Stelara with step therapy criteria—patients typically need documented failure of preferred biologics or contraindications. Fastest path: Submit complete PA request with TB screening, disease severity scores (PASI >10 for psoriasis, CDAI >
6 min read

How to Get HyperHEP (Hepatitis B Immune Globulin) Covered by Aetna CVS Health in Virginia: Complete Appeals Guide

Quick Answer: Getting HyperHEP Covered by Aetna CVS Health in Virginia HyperHEP (hepatitis B immune globulin) requires prior authorization from Aetna CVS Health and is covered for post-exposure prophylaxis and liver transplant prevention. The fastest path to approval: have your doctor submit clinical documentation showing qualifying exposure or transplant status
6 min read