Topic

Virginia

A collection of 409 issues

How to Get Elaprase (idursulfase) Covered by Blue Cross Blue Shield in Virginia: Complete Appeals Guide

Answer Box: Getting Elaprase Covered by Blue Cross Blue Shield in Virginia Blue Cross Blue Shield Virginia requires prior authorization for Elaprase (idursulfase) based on confirmed Hunter syndrome diagnosis and weight-based dosing calculations. The fastest path to approval: (1) Submit enzymatic and genetic test results confirming MPS II, (2) Include

How to Get Trikafta Covered by UnitedHealthcare in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Trikafta Covered by UnitedHealthcare in Virginia To get Trikafta (elexacaftor/tezacaftor/ivacaftor) covered by UnitedHealthcare in Virginia, you need prior authorization with documented CFTR genotype testing showing responsive mutations, baseline liver function tests, and confirmed cystic fibrosis diagnosis. If denied, Virginia offers a robust external review process

How to Get Soliris (eculizumab) Covered by Aetna in Virginia: Forms, Appeals & Contact Guide

Answer Box: Get Soliris Covered by Aetna in Virginia Soliris (eculizumab) requires prior authorization from Aetna CVS Health for all FDA-approved indications including PNH, aHUS, generalized myasthenia gravis, and NMOSD. The fastest path: submit electronically through CoverMyMeds or Surescripts (decisions in 6 seconds), include specific antibody/lab results for your

Myths vs. Facts: Getting Evkeeza (Evinacumab-dgnb) Covered by Cigna in Virginia

Answer Box: Getting Evkeeza Covered by Cigna in Virginia Eligibility: Evkeeza requires prior authorization from Cigna for homozygous familial hypercholesterolemia (HoFH) patients ≥5 years old with genetic confirmation or clinical criteria, plus documented inadequate response to PCSK9 inhibitors (ages ≥10). Fastest path: Submit complete documentation through Cigna's provider

Renewing Signifor / Signifor LAR (Pasireotide) Approval with Cigna in Virginia: 2025 Requirements, Timeline & Evidence Guide

Answer Box: Renewing Your Signifor LAR Coverage Cigna typically approves Signifor LAR renewals for 12 months when you demonstrate ongoing clinical response. For Cushing's disease, you'll need recent UFC (urinary free cortisol) showing reduction from baseline. For acromegaly, provide age-adjusted IGF-1 normalization or GH <1.

How to Get Firazyr (Icatibant) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization Guide

Answer Box: Getting Firazyr Covered by Aetna CVS Health in Virginia Fastest path to approval: Submit the Aetna Firazyr-Sajazir Precertification Request form with confirmed HAE diagnosis (ICD-10: D84.1), specialist documentation, and attack logs. Standard decision: 30-45 days. If denied, Virginia residents can file external review within 120 days through

Myths vs. Facts: Getting Kineret (Anakinra) Covered by Cigna in Virginia - Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Kineret (Anakinra) Covered by Cigna in Virginia Fastest path to approval: Your rheumatologist must document failed trials of conventional DMARDs (typically methotrexate) and at least one biologic for rheumatoid arthritis, then submit Cigna's prior authorization form with clinical notes showing medical necessity. For NOMID/CAPS,

Getting Ilaris (Canakinumab) Covered by Humana in Virginia: Complete Prior Authorization and Appeal Guide

Quick Answer: Your Path to Ilaris Coverage Humana requires prior authorization for Ilaris (canakinumab) in Virginia. Start by having your doctor submit clinical documentation showing your Still's disease or periodic fever syndrome diagnosis, prior treatment failures, and medical necessity. If denied, you have 65 days to appeal internally,

How to Get Berinert (C1-Esterase Inhibitor) Covered by Aetna CVS Health in Virginia: Complete PA Guide with Appeal Scripts

Answer Box: Fast Track to Berinert Coverage Yes, Berinert requires prior authorization from Aetna CVS Health in Virginia. To get approved: (1) Have your allergist/immunologist submit a PA request through Availity portal with HAE diagnosis confirmation, attack documentation, and medical necessity letter; (2) Include lab results (low C1-INH, low

Getting Evrysdi (Risdiplam) Covered by Cigna in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: To get Evrysdi (risdiplam) covered by Cigna in Virginia, you'll need prior authorization with genetic testing confirming SMA (SMN1 mutations), baseline motor function assessment, and specialist involvement. Submit via CoverMyMeds or fax (855) 840-1678. If denied, use Virginia's external review process through the State