Topic

Virginia

A collection of 404 issues

Myths vs. Facts: Getting Busulfex (busulfan injection) Covered by Blue Cross Blue Shield in Virginia

Quick Answer: Getting Busulfex Covered by Blue Cross Blue Shield in Virginia Yes, Blue Cross Blue Shield (BCBS) Virginia covers Busulfex (busulfan injection) for FDA-approved transplant conditioning, but prior authorization is typically required. Most denials stem from missing documentation or procedural errors, not medical necessity. Your fastest path: 1) Verify

How to Get Trikafta Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide 2024

Answer Box: Getting Trikafta Covered by Aetna CVS Health in Virginia Trikafta requires prior authorization from Aetna CVS Health in Virginia. Submit complete documentation including CFTR genotype testing showing F508del mutation, CF diagnosis with ICD-10 codes E84.0-E84.9, and baseline liver function tests. If denied, appeal within 180 days

Renewing iLink® Corneal Cross-Linking Coverage with UnitedHealthcare in Virginia: Timeline, Documentation & Appeals Guide

Quick Answer: Renewing Your iLink® Coverage UnitedHealthcare requires annual prior authorization renewal for iLink® corneal cross-linking. Start the renewal process 4-6 weeks before your current authorization expires. You'll need updated corneal topography showing continued progression, a medical necessity letter from your ophthalmologist, and evidence of treatment response. Submit

How to Get Daybue (Trofinetide) Covered by Cigna in Virginia: Complete PA Guide with Forms and Appeal Timeline

Answer Box: Getting Daybue (Trofinetide) Covered by Cigna in Virginia Cigna requires prior authorization for Daybue (trofinetide) through their specialty pharmacy Accredo. Key requirements: confirmed Rett syndrome diagnosis with MECP2 genetic testing, patient age ≥2 years, and specialist prescriber (neurologist/geneticist). If denied, you have 180 days to file an

The Requirements Checklist to Get Elfabrio (pegunigalsidase alfa-iwxj) Covered by Cigna in Virginia

Answer Box: Getting Elfabrio Covered by Cigna in Virginia Eligibility: Adults with confirmed Fabry disease (genetic testing or enzyme deficiency) can get Elfabrio covered by Cigna without step therapy as of March 2024. Fastest path: Submit complete prior authorization with ICD-10 code E75.21, HCPCS J0219, specialist prescription, and genetic/

How to Get Prolastin-C Covered by Cigna in Virginia: Complete Prior Authorization Guide

Answer Box: Getting Prolastin-C Covered by Cigna in Virginia Prolastin-C requires prior authorization from Cigna in Virginia. To get approved, you need: (1) documented alpha1-antitrypsin deficiency with severe genotype (Pi*ZZ), (2) AAT serum level <11 mcmol/L, and (3) lung function evidence (FEV1 <65% predicted or accelerated

How to Get Tecentriq (atezolizumab) Covered by UnitedHealthcare in Virginia: Complete Coding, Appeals, and Authorization Guide

Answer Box: Getting Tecentriq Covered by UnitedHealthcare in Virginia Tecentriq (atezolizumab) requires prior authorization from UnitedHealthcare and follows medical benefit billing using HCPCS code J9022. Your fastest path to approval: 1) Submit PA request with required PD-L1 testing results and proper ICD-10 codes (C34.x for lung cancer, C22.0

Aetna (CVS Health)'s Coverage Criteria for Pemazyre (pemigatinib) in Virginia: What Counts as "Medically Necessary"?

Quick Answer: Getting Pemazyre (pemigatinib) Covered by Aetna (CVS Health) in Virginia Pemazyre requires prior authorization from Aetna (CVS Health) and is typically non-formulary, requiring a formulary exception. The fastest path to approval: (1) Submit complete documentation including positive FGFR2/FGFR1 molecular test results, prior therapy history, and baseline ophthalmologic

Renewing Vimizim (Elosulfase Alfa) Coverage with Humana in Virginia: Complete Guide to Timelines, Documentation, and Appeals

Answer Box: Fast Track to Vimizim Renewal Humana requires prior authorization renewal for Vimizim (elosulfase alfa) in Virginia with specific documentation proving ongoing medical necessity. Start your renewal 2-4 weeks before expiration to avoid treatment gaps. Submit updated clinical assessments (6-minute walk test, pulmonary function), chart notes showing therapeutic response,

Get Eloctate Covered by Aetna CVS Health in Virginia: Complete Guide to Prior Authorization, Appeals, and Approval

Answer Box: Quick Path to Eloctate Coverage Eloctate is covered by Aetna CVS Health in Virginia as a preferred specialty drug requiring prior authorization. Your hematologist must submit clinical documentation through Aetna's provider portal, including hemophilia A diagnosis, bleeding history, and dosing rationale. Standard decisions take 30-45 days;