Topic

Virginia

A collection of 470 issues

How to Get Isturisa (Osilodrostat) Covered by Aetna (CVS Health) in Virginia: Complete Guide with Forms, Appeals, and Timelines

Quick Answer: Getting Isturisa (Osilodrostat) Approved by Aetna (CVS Health) in Virginia Aetna requires prior authorization for Isturisa (osilodrostat) in adults with confirmed Cushing's disease when surgery has failed or is contraindicated. Submit the specialty PA form via Aetna's provider portal or fax to 1-877-269-9916 with

Do You Qualify for Bylvay (odevixibat) Coverage by Blue Cross Blue Shield in Virginia? Decision Tree & Next Steps

Answer Box: To get Bylvay (odevixibat) covered by Blue Cross Blue Shield in Virginia, you need: (1) confirmed PFIC or Alagille syndrome diagnosis from a GI specialist, (2) age 3+ months for PFIC or 12+ months for Alagille, and (3) documentation of symptom severity. Submit prior authorization through your doctor&

Requirements Checklist to Get Qinlock (ripretinib) Covered by Aetna CVS Health in Virginia

Answer Box: Getting Qinlock (ripretinib) Covered by Aetna CVS Health in Virginia Eligibility: Qinlock requires prior authorization from Aetna CVS Health for fourth-line GIST treatment after documented failure of imatinib, sunitinib, and regorafenib. Fastest path: Submit complete documentation including pathology report, treatment history with outcomes, and medical necessity letter through

Myths vs. Facts: Getting Signifor / Signifor LAR (pasireotide) Covered by UnitedHealthcare in Virginia

Answer Box: UnitedHealthcare requires prior authorization for Signifor/Signifor LAR (pasireotide) through OptumRx, with approval based on confirmed endogenous Cushing's disease or acromegaly, specialist prescriber, and documented surgical failure. In Virginia, if denied, you have 180 days for internal appeals and 120 days for external review through the

Work With Your Doctor to Get Spinraza (nusinersen) Approved by Aetna (CVS Health) in Virginia: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Spinraza Covered by Aetna (CVS Health) in Virginia Aetna (CVS Health) requires prior authorization for all Spinraza (nusinersen) prescriptions in Virginia. Your neurologist must submit genetic testing confirming 5q SMA, baseline motor function assessment (HINE-2, HFMSE, or CHOP-INTEND), and clinical documentation showing you're not on

How to Get Acthar Gel Covered by Cigna in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Cigna requires prior authorization for all Acthar Gel (repository corticotropin injection) indications, with mandatory step therapy proving corticosteroid failure or intolerance. Submit PA through Express Scripts/Accredo with comprehensive clinical documentation. If denied, Virginia residents can appeal internally within 180 days, then pursue external review through the State

How to Get Tysabri (Natalizumab) Covered by Humana in Virginia: Complete Guide with Forms and Appeals

Answer Box: Getting Tysabri Covered by Humana in Virginia Tysabri (natalizumab) requires prior authorization from Humana and is typically placed on Tier 4 (Specialty) with 25-33% coinsurance. The fastest path to approval: Have your doctor submit a PA request with TOUCH program enrollment, JCV antibody results, and documentation of inadequate

The Requirements Checklist to Get Naglazyme (galsulfase) Covered by Humana in Virginia

Answer Box: Getting Naglazyme (galsulfase) Covered by Humana in Virginia Naglazyme (galsulfase) requires prior authorization from Humana with standard reviews taking up to 30 days and expedited reviews within 72 hours if physician-certified as urgent. Virginia patients have strong appeal rights through the State Corporation Commission's external review

How to Get Filsuvez (Birch Triterpenes Topical Gel) Covered by Humana in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Filsuvez Covered by Humana in Virginia Filsuvez (birch triterpenes topical gel) requires prior authorization from Humana for epidermolysis bullosa wound care. Submit your PA request through Humana's provider portal or call 855-223-9868. Include genetic testing confirming junctional or dystrophic EB, wound documentation, and failed standard

How to Get Mepsevii (Vestronidase Alfa-vjbk) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Mepsevii Covered by Aetna CVS Health in Virginia Mepsevii (vestronidase alfa-vjbk) requires prior authorization from Aetna CVS Health under Clinical Policy Bulletin 0442. Key requirements: confirmed MPS VII diagnosis via enzyme assay or genetic testing, prescription by a metabolic specialist, and elevated urinary glycosaminoglycans ≥2x normal levels.