Topic

Virginia

A collection of 47 issues

How to Get Elelyso (taliglucerase alfa) Covered by Aetna CVS Health in Virginia: Complete Guide with Forms and Appeal Process

Quick Answer: Getting Elelyso Covered by Aetna CVS Health in Virginia Elelyso (taliglucerase alfa) requires prior authorization from Aetna CVS Health in Virginia and is typically not on standard formularies. Here's your fastest path to approval: 1. Confirm diagnosis with enzyme deficiency or genetic testing results 2. Submit

Get Tecentriq (Atezolizumab) Covered by Blue Cross Blue Shield in Virginia: Complete Prior Authorization Guide

Answer Box: Tecentriq (atezolizumab) requires prior authorization from Blue Cross Blue Shield in Virginia for all 2024 plans. Success depends on meeting FDA-approved indication criteria, proper PD-L1 testing (≥1% for adjuvant NSCLC, ≥50% for first-line metastatic), and comprehensive documentation. If denied, you have 120 days to file an external review

Getting Jaypirca (Pirtobrutinib) Approved by UnitedHealthcare in Virginia: Complete Guide to Coverage, Appeals, and Forms

Answer Box: Fast Track to Jaypirca Coverage in Virginia Getting Jaypirca (pirtobrutinib) approved by UnitedHealthcare in Virginia requires prior authorization and documentation of failed BTK inhibitor therapy. The fastest path: 1) Gather records of prior BTK inhibitor treatment (ibrutinib, acalabrutinib, or zanubrutinib) and failure/intolerance, 2) Submit complete prior authorization

How to Get Advate (Octocog Alfa) Covered by Blue Cross Blue Shield in Virginia: Coding, Appeals, and Prior Authorization Guide

Answer Box: Getting Advate Covered in Virginia Anthem Blue Cross Blue Shield Virginia requires prior authorization for Advate (octocog alfa) using HCPCS code J7194 and ICD-10 code D66. Submit PA requests through the Availity Essentials portal with complete clinical documentation including hemophilia A diagnosis, factor VIII levels, and treatment history.

How to Get Fintepla (fenfluramine) Covered by Cigna in Virginia: Prior Authorization, Appeals & REMS Requirements

Answer Box: Getting Fintepla Covered by Cigna in Virginia Cigna requires prior authorization for Fintepla (fenfluramine) in Virginia with strict REMS enrollment and echocardiography requirements. Here's your fastest path to approval: 1. Ensure REMS compliance: Both prescriber and patient must be enrolled in the Fintepla REMS program before

How to Get Rylaze Covered by Cigna in Virginia: Complete Decision Tree, Forms & Appeal Guide

Answer Box: Getting Rylaze Covered by Cigna in Virginia You can get Rylaze (asparaginase erwinia chrysanthemi [recombinant]-rywn) covered by Cigna in Virginia if you meet specific criteria. The fastest path: 1) Confirm your ALL/LBL diagnosis and documented E. coli asparaginase hypersensitivity, 2) Have your oncologist submit Cigna'

How to Get Imbruvica (Ibrutinib) Covered by Cigna in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Imbruvica (ibrutinib) covered by Cigna in Virginia requires prior authorization through Express Scripts, with specific diagnosis codes and treatment history documentation. If denied, Virginia's State Corporation Commission offers external review within 120 days. Start by having your hematologist/oncologist complete Cigna's oncology PA

Get Rebif (Interferon Beta-1a) Covered by Cigna in Virginia: Forms, Appeals & State Resources

Answer Box: Getting Rebif Approved by Cigna in Virginia To get Rebif (interferon beta-1a) covered by Cigna in Virginia, your doctor must submit a prior authorization through CoverMyMeds or SureScripts, including recent CBC and liver function tests, your MS diagnosis details, and documentation of any prior DMT failures. If denied,

Renewing Fabrazyme (Agalsidase Beta) Coverage with Aetna in Virginia: Timeline, Documentation, and Bridge Options

Answer Box: Fabrazyme Renewal with Aetna in Virginia Key Steps: (1) Submit renewal documentation 30 days before current authorization expires, (2) Include updated specialist evaluation and lab results showing continued medical necessity, (3) Use Aetna's provider portal or fax to submit required forms. Timeline: Standard decisions within 14

How to Get Translarna (Ataluren) Covered by Aetna CVS Health in Virginia: Complete Timeline and Appeals Guide

Answer Box: Getting Translarna Covered by Aetna CVS Health in Virginia Important: Translarna (ataluren) is not FDA-approved in the United States as of 2025. However, if you're seeking coverage through expanded access or clinical trials, here's the fastest path: 1. Confirm genetic testing shows nonsense mutation