Topic

Virginia

A collection of 471 issues

Qinlock (Ripretinib) Approval with Humana in Virginia: Answers to the Most Common Questions

Answer Box: Getting Qinlock Covered by Humana in Virginia Qinlock (ripretinib) requires prior authorization from Humana with documented failure of three prior kinase inhibitors: imatinib, sunitinib, and regorafenib. Submit PA via Humana's provider portal with complete treatment history, pathology confirming advanced GIST, and imaging showing disease progression. Standard

How to Get Kesimpta (ofatumumab) Covered by UnitedHealthcare in Virginia: Appeals Guide with Forms and Timelines

Answer Box: Getting Kesimpta Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Kesimpta (ofatumumab) with step therapy requirements in Virginia. Most denials stem from missing documentation or inadequate prior DMT failure records. Your fastest path: 1) Gather complete medical records showing relapsing MS diagnosis and prior treatment failures,

Myths vs. Facts: Getting Sumavel DosePro (Sumatriptan Injection, Needle-Free) Covered by Cigna in Virginia

Answer Box: Sumavel DosePro was discontinued in the U.S., but similar needle-free sumatriptan injections require Cigna prior authorization with step therapy (oral triptan failure first). In Virginia, submit PA via your doctor using Cigna's provider portal, expect 3-5 business days for review, and if denied, file internal

How to Get Enhertu (Fam-Trastuzumab Deruxtecan-nxki) Approved by Humana in Virginia: Timeline, Forms & Appeal Process

Answer Box: Your Path to Enhertu Coverage Getting Enhertu (fam-trastuzumab deruxtecan-nxki) covered by Humana in Virginia requires prior authorization with HER2 testing documentation and medical necessity justification. Standard decisions take 7-14 days; expedited reviews complete within 72 hours if your health is at serious risk. Start by having your oncologist

Get Jaypirca (Pirtobrutinib) Covered by Blue Cross Blue Shield in Virginia: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Jaypirca Covered in Virginia Jaypirca (pirtobrutinib) requires prior authorization from Blue Cross Blue Shield (BCBS) in Virginia. The fastest path to approval: (1) Your oncologist documents failed BTK inhibitor therapy and bleeding risk mitigation, (2) submits PA via Availity Essentials, and (3) appeals any denial with peer-reviewed

How to Get Rezlidhia (Olutasidenib) Covered by UnitedHealthcare in Virginia: Complete PA Guide and Appeals Process

Answer Box: Getting Rezlidhia Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Rezlidhia (olutasidenib) with strict documentation of IDH1 mutation and relapsed/refractory AML status. Submit via OptumRx e-PA portal with molecular testing results, treatment history, and monitoring plan. If denied, Virginia's State Corporation Commission provides

Work With Your Doctor to Get Rinvoq (Upadacitinib) Approved by UnitedHealthcare in Virginia: Complete Provider Collaboration Guide

Quick Answer: Getting Rinvoq Approved in Virginia UnitedHealthcare requires prior authorization for Rinvoq (upadacitinib) with mandatory step therapy—typically requiring failure of at least one TNF inhibitor biologic first. Your fastest path: work with your rheumatologist to submit a comprehensive prior authorization through OptumRx including documented TNF failure, required lab

How to Get Hemgenix (etranacogene dezaparvovec) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Hemgenix Covered by Aetna CVS Health in Virginia Hemgenix (etranacogene dezaparvovec) requires prior authorization from Aetna CVS Health. Adults with severe hemophilia B (≤2% Factor IX) on prophylaxis or with serious bleeding history can qualify. Submit complete documentation including Factor IX levels, inhibitor tests, bleeding history, and

Get Strensiq (Asfotase Alfa) Approved by Aetna (CVS Health) in Virginia: Complete Prior Authorization & Appeals Guide

Answer Box: Quick Start for Virginia Patients Strensiq (asfotase alfa) requires prior authorization from Aetna (CVS Health) in Virginia. To get approved, you need documented pediatric-onset hypophosphatasia with genetic/biochemical confirmation, radiographic evidence, and specialist prescription. Start today: Have your doctor complete Aetna's current Strensiq precertification form and

Get Ilaris (Canakinumab) Covered by Cigna in Virginia: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Ilaris (Canakinumab) Covered by Cigna in Virginia Cigna covers Ilaris (canakinumab) for FDA-approved conditions like Still's disease and periodic fever syndromes under Policy IP0235, requiring prior authorization with specific criteria. To get approval in Virginia: 1. Gather documentation: CRP ≥10 mg/L (within 3 months)