Topic

Virginia

A collection of 236 issues

Work With Your Doctor to Get Rapivab (Peramivir) Covered by Aetna CVS Health in Virginia: Complete Provider Partnership Guide

Answer Box: Getting Rapivab Covered by Aetna CVS Health in Virginia Rapivab (peramivir) requires prior authorization from Aetna CVS Health. The fastest path to approval: work closely with your doctor to document why IV antiviral therapy is medically necessary over oral options like Tamiflu. Your provider must submit a detailed

The Complete Guide to Getting Abecma (idecabtagene vicleucel) Covered by Cigna in Virginia: Prior Authorization, Appeals, and State Resources

Answer Box: Getting Abecma Covered by Cigna in Virginia Cigna requires prior authorization for Abecma (idecabtagene vicleucel) in Virginia. To get approval, you need: (1) confirmed relapsed/refractory multiple myeloma after ≥2 prior therapy lines including an IMiD, proteasome inhibitor, and anti-CD38 antibody, (2) treatment at a Bristol Myers Squibb-certified

Coding That Helps Get Galafold (Migalastat) Approved by Cigna in Virginia: ICD-10, HCPCS, and NDC Guide

Answer Box: Getting Galafold Covered by Cigna in Virginia Getting Galafold (migalastat) approved by Cigna requires precise coding and complete documentation. Use ICD-10 code E75.21 for Fabry disease, submit through pharmacy benefit (not medical), and include genetic confirmation of amenable GLA variant. Virginia patients have strong appeal rights through

How to Get Bavencio (avelumab) Approved by UnitedHealthcare in Virginia: Complete Prior Authorization Guide

Quick Answer: Getting Bavencio Covered by UnitedHealthcare in Virginia Bavencio (avelumab) requires prior authorization through UnitedHealthcare's OptumRx pharmacy benefit. For fastest approval: (1) Submit your PA request via the UnitedHealthcare Provider Portal at UHCprovider.com or call 866-889-8054, (2) Include complete documentation of platinum-based chemotherapy failure with recent

Myths vs. Facts: Getting Haegarda (C1-esterase inhibitor, SC) Covered by Aetna (CVS Health) in Virginia

Answer Box: Getting Haegarda Covered by Aetna (CVS Health) in Virginia Eligibility: Confirmed HAE diagnosis (lab evidence + ICD-10 D84.1), age ≥6 years, specialist involvement, and documented attack history. Fastest path: Submit complete Aetna Haegarda Precertification Request Form with all clinical documentation via CVS Specialty Pharmacy. First step today: Contact

How to Get Cresemba (Isavuconazole) Covered by Blue Cross Blue Shield in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Cresemba Covered by Blue Cross Blue Shield in Virginia Blue Cross Blue Shield Virginia (Anthem) requires prior authorization for Cresemba (isavuconazole), with approval typically taking 5-15 business days. Your fastest path: (1) Verify your plan's specialty pharmacy network and formulary tier, (2) Have your doctor

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

Answer Box: Getting Joenja (leniolisib) Covered by Cigna in Virginia Cigna requires prior authorization for Joenja (leniolisib) with strict criteria: genetic confirmation of APDS via CLIA-certified testing, specialist prescription (immunologist/geneticist), patient age ≥12 years and weight ≥45 kg. Submit electronically via CoverMyMeds with complete documentation. If denied, Virginia residents

If Amondys 45 Isn't Approved by Blue Cross Blue Shield in Virginia: Formulary Alternatives & Exception Paths

Quick Answer: Your Options When BCBS Virginia Excludes Amondys 45 Blue Cross Blue Shield plans in Virginia typically exclude Amondys 45 (casimersen) as "not medically necessary." However, you have alternatives: Exondys 51 (eteplirsen) is covered for exon 51-amenable mutations, formulary exceptions may be possible with compelling medical necessity

How to Get Strensiq (Asfotase Alfa) Covered by UnitedHealthcare in Virginia: Complete Prior Authorization Guide

Answer Box: Getting Strensiq Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Strensiq (asfotase alfa) with strict medical necessity criteria. You'll need confirmed pediatric-onset hypophosphatasia, low serum alkaline phosphatase levels, genetic testing results, and prescription by an endocrinologist. Submit via the OptumRx Provider Portal or call

Get Orladeyo (berotralstat) Approved by UnitedHealthcare in Virginia: Complete Guide to Prior Authorization, Appeals, and Coverage

Answer Box: Getting Orladeyo (berotralstat) Covered by UnitedHealthcare in Virginia Orladeyo requires prior authorization from UnitedHealthcare and is subject to step therapy requirements. Most patients must try and fail other HAE prophylaxis drugs first. The fastest path to approval: (1) Have your HAE specialist complete UnitedHealthcare's prior authorization