Topic

Virginia

A collection of 409 issues

Do You Qualify for Idelvion Coverage by Blue Cross Blue Shield in Virginia? Decision Tree & Appeal Guide

Answer Box: Idelvion (albutrepenonacog alfa) requires prior authorization from Blue Cross Blue Shield in Virginia for hemophilia B patients. You qualify if you have confirmed Factor IX deficiency (<40% activity), documented bleeding history, and have tried standard Factor IX products for 50+ exposure days. Start by having your hematologist

How Long Does It Take to Get Firazyr (icatibant) Approved by UnitedHealthcare in Virginia? Complete Timeline & Appeals Guide

Answer Box: Getting Firazyr Approved by UnitedHealthcare in Virginia Timeline: Standard prior authorization takes 1-7 days; expedited reviews within 72 hours for urgent cases. Requirements: Confirmed HAE diagnosis, specialist prescription (immunologist/allergist), documentation of prior therapy failures, and self-administration training records. First step: Have your HAE specialist submit a complete

How to Get Givlaari (givosiran) Covered by Cigna in Virginia: Complete Coding, Appeals & External Review Guide

Quick Answer: Getting Givlaari (givosiran) Covered by Cigna in Virginia Eligibility: Adults with acute hepatic porphyria (AHP) who have documented elevated ALA/PBG levels and ≥2 attacks in 6 months. Fastest path: Have your specialist submit prior authorization with ICD-10 code E80.21, attack logs, and lab results showing elevated

Blue Cross Blue Shield Virginia's Coverage Criteria for Berinert (C1-Esterase Inhibitor): What Counts as "Medically Necessary"?

Answer Box: Getting Berinert Covered in Virginia Blue Cross Blue Shield Virginia requires prior authorization for Berinert with specific medical necessity criteria: confirmed HAE diagnosis, specialist involvement, and documentation of attack frequency. Fastest path: Have your allergist/immunologist submit PA with C1-INH lab values, attack history, and failed first-line treatments.

How to Get Isturisa (Osilodrostat) Covered by UnitedHealthcare in Virginia: Complete Timeline & Appeals Guide

Answer Box: Getting Isturisa Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Isturisa (osilodrostat) in Virginia, with decisions typically taking 1-5 business days for complete submissions. The fastest path: (1) Have your endocrinologist gather complete diagnostic labs (UFC, salivary cortisol, DST), surgical history, and medical necessity documentation, (2)

Getting Amvuttra (Vutrisiran) Covered by Humana in Virginia: Complete Guide to Forms, Appeals, and Prior Authorization

Answer Box: Getting Started with Humana Coverage for Amvuttra in Virginia To get Amvuttra (vutrisiran) covered by Humana in Virginia, you'll need prior authorization with genetic testing proving TTR mutation, documentation of failed alternatives, and specialty pharmacy dispensing. Start by having your provider submit a PA request through

How to Get Tremfya (Guselkumab) Covered by Blue Cross Blue Shield Virginia: Prior Authorization Forms, Appeals, and Step-by-Step Guide

Answer Box: Getting Tremfya (Guselkumab) Covered by Blue Cross Blue Shield Virginia Tremfya (guselkumab) requires prior authorization from Blue Cross Blue Shield Virginia (Anthem). The fastest path to approval involves three steps: 1) Submit complete prior authorization documentation including PASI scores and failed therapy history through Anthem's Availity

How to Get Therakos CELLEX Photopheresis Covered by UnitedHealthcare in Virginia: Complete Appeal Guide with Forms and Timelines

Quick Answer: Getting UnitedHealthcare to Cover Therakos CELLEX in Virginia UnitedHealthcare requires prior authorization for Therakos CELLEX photopheresis, but coverage is provided when medical necessity criteria are met for conditions like steroid-refractory GVHD and advanced CTCL. The fastest path to approval: (1) Submit PA request through UHC provider portal with

How to Get Naglazyme (galsulfase) Covered by Blue Cross Blue Shield in Virginia: Complete Prior Authorization Guide

Answer Box: Getting Naglazyme Covered by Blue Cross Blue Shield in Virginia Blue Cross Blue Shield Virginia requires prior authorization for Naglazyme (galsulfase), with coverage based on confirmed MPS VI diagnosis, documented functional impairment, and objective outcome measures. The fastest path to approval involves submitting comprehensive documentation through Anthem'

How to Get Darzalex / Darzalex Faspro (daratumumab) Covered by Aetna (CVS Health) in Virginia: Complete Guide to Prior Authorization, Appeals, and State Protections

Answer Box: Your Fastest Path to Coverage Getting Darzalex / Darzalex Faspro (daratumumab) covered by Aetna (CVS Health) in Virginia requires prior authorization and often step therapy compliance. Your oncologist must document that bortezomib (the preferred agent) has failed or is contraindicated. Submit Aetna's precertification form via phone (1-866-752-7021)