Topic

Virginia

A collection of 392 issues

How to Get Kuvan (Sapropterin) Approved by UnitedHealthcare in Virginia: Complete Prior Authorization Guide

Quick Answer: Getting Kuvan Approved by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Kuvan (sapropterin) through OptumRx, typically approving within 24-72 hours when you submit complete documentation. You'll need: confirmed PKU diagnosis (ICD-10 E70.0), recent phenylalanine levels, proof of phenylalanine-restricted diet, and metabolic specialist prescription. Submit

Getting Translarna (Ataluren) Covered by Humana in Virginia: Prior Authorization Guide and Appeal Process

Answer Box: How to Get Translarna (Ataluren) Covered by Humana in Virginia Translarna (ataluren) requires prior authorization from Humana and is typically not on standard formularies. Your fastest path to coverage: 1. Confirm genetic testing shows nonsense mutation Duchenne muscular dystrophy (nmDMD) 2. Document corticosteroid trial/failure to meet step

How to Get Qalsody (tofersen) Covered by Humana in Virginia: Complete Prior Authorization Guide

Answer Box: Getting Qalsody (tofersen) Covered by Humana in Virginia Yes, Humana covers Qalsody for SOD1-ALS patients in Virginia under Medicare Part B. Following CMS's December 2024 directive, Medicare Advantage plans must cover Qalsody when medically necessary. Your fastest path to approval: Have your neurologist submit prior authorization

How to Get Nourianz (Istradefylline) Covered by Aetna CVS Health in Virginia: Complete Appeals Guide

Quick Answer: To get Nourianz (istradefylline) covered by Aetna CVS Health in Virginia, you'll need prior authorization with documented OFF episodes, failed trials of amantadine or MAO-B/COMT inhibitors, and neurologist prescription. If denied, Virginia's Bureau of Insurance offers free external review using Form 216-A within

How to Get Crysvita (burosumab) Covered by Anthem Blue Cross Blue Shield Virginia: Prior Authorization, Appeals & External Review Guide

Answer Box: Getting Crysvita Covered by Anthem BCBS Virginia Anthem Blue Cross Blue Shield Virginia requires prior authorization for Crysvita (burosumab) with strict clinical criteria. To get approval: (1) Your endocrinologist submits genetic XLH confirmation plus low serum phosphorus labs via Anthem's clinical criteria portal, (2) Document failed/

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

Answer Box: Getting Vitrakvi (Larotrectinib) Covered by Aetna CVS Health in Virginia Aetna CVS Health requires prior authorization for Vitrakvi with three key requirements: confirmed NTRK gene fusion via validated testing, metastatic/unresectable solid tumor status, and documented failure or unsuitability of standard therapies. The fastest path to approval: (1)

Denied for Fintepla (Fenfluramine) by UnitedHealthcare in Virginia? Complete Appeal Guide with Forms & Timelines

Answer Box: Getting Fintepla Covered by UnitedHealthcare in Virginia Fintepla (fenfluramine) requires prior authorization from UnitedHealthcare and typically must be filled through OptumRx specialty pharmacy. If denied, you have 180 days to appeal internally, then 120 days for Virginia's external review. First step today: Call the number on

How to Get Arikayce Covered by Aetna CVS Health in Virginia: Prior Authorization Guide and Appeals Process

Answer Box: To get Arikayce covered by Aetna CVS Health in Virginia, you need prior authorization proving refractory MAC lung disease with 6+ months of failed standard therapy. Submit PA via Aetna's specialty pharmacy portal with culture results, treatment history, and pulmonologist documentation. If denied, file internal appeal

Get Ferriprox (Deferiprone) Covered by Cigna in Virginia: Complete PA Guide and Appeal Scripts

Answer Box: Your Fastest Path to Approval Cigna requires prior authorization for Ferriprox (deferiprone) through Express Scripts/Accredo specialty pharmacy. Submit the Iron Chelating Agents PA form with documented serum ferritin >1,000 mcg/L (thalassemia) or >300 mcg/L (other transfusional overload), baseline ANC ≥1.5×10⁹

Blue Cross Blue Shield Virginia's Coverage Criteria for Luxturna: What Counts as "Medically Necessary"?

Answer Box: Getting Luxturna Covered in Virginia Blue Cross Blue Shield Virginia requires prior authorization for Luxturna (voretigene neparvovec-rzyl) with documented biallelic RPE65 mutations, retinal viability testing, and treatment at a qualified center. Your fastest path to approval: 1) Order genetic testing immediately if absent, 2) Submit PA with OCT