Topic

Virginia

A collection of 47 issues

How to Get Bavencio (Avelumab) Covered by Blue Cross Blue Shield in Virginia: Complete Appeals Guide 2025

Answer Box: Getting Bavencio Covered in Virginia Bavencio (avelumab) is covered by Blue Cross Blue Shield in Virginia but requires prior authorization. The fastest path to approval: 1) Your oncologist submits prior authorization with complete clinical documentation to Anthem BCBS Virginia, 2) Include diagnosis confirmation, prior treatment history, and medical

Denied for Jynarque (Tolvaptan) by Humana in Virginia? Complete Appeal Guide with Forms & Templates

Quick Answer: To get Jynarque (tolvaptan) covered by Humana in Virginia, you'll need prior authorization showing rapid ADPKD progression (Mayo Class 1C-1E or eGFR decline ≥3.0 ml/min/1.73m²/year), REMS enrollment, and baseline liver function tests. If denied, you have 65 days to appeal to

How to Get Revlimid (Lenalidomide) Covered by Cigna in Virginia: Appeals Process and Alternative Options

Answer Box: Getting Revlimid Covered by Cigna in Virginia Quick Path to Coverage: If Cigna denies your Revlimid (lenalidomide) prescription, you have three main options: (1) Request a formulary exception with medical necessity documentation, (2) Consider generic lenalidomide as an alternative, or (3) Appeal through Cigna's internal process

Myths vs. Facts: Getting Upstaza (eladocagene exuparvovec) Covered by Cigna in Virginia

Quick Answer: Getting Upstaza Covered by Cigna in Virginia Myth: If your doctor prescribes Upstaza, Cigna automatically covers it. Fact: Cigna requires prior authorization with genetic confirmation of AADC deficiency, documented treatment failures, and administration at a certified neurosurgical center. In Virginia, if denied, you have 180 days for internal

Getting Oxbryta (Voxelotor) Covered by Aetna CVS Health in Virginia: 2024 Updates, Appeals, and Alternatives

Quick Answer: Oxbryta Coverage Status in Virginia Important Update: Oxbryta (voxelotor) is no longer FDA-approved in the United States as of 2024. Pfizer withdrew the drug following a confirmatory evidence review. If you're in Virginia with Aetna CVS Health coverage and need sickle cell disease treatment, focus on

How to Get Ferriprox (deferiprone) Covered by UnitedHealthcare in Virginia: Complete Appeals Guide

Answer Box: Getting Ferriprox Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Ferriprox (deferiprone) with step therapy requirements. Patients must typically try deferasirox or deferoxamine first unless contraindicated. To get approval: 1) Document transfusional iron overload diagnosis with ICD-10 E83.111, 2) Show prior chelator failures or contraindications,

When Fabrazyme Isn't Approved by UnitedHealthcare in Virginia: Formulary Alternatives & Exception Paths

Answer Box: Getting Fabrazyme Coverage Through UnitedHealthcare in Virginia If UnitedHealthcare denies Fabrazyme (agalsidase beta) for Fabry disease, you'll likely need to try their preferred alternative Elfabrio first due to step therapy requirements. Document any clinical reasons why Elfabrio isn't suitable, then request a formulary exception

Work With Your Doctor to Get Ruconest Covered by Aetna CVS Health in Virginia: Provider Collaboration Guide

Quick Answer: Your Path to Ruconest Coverage Getting Ruconest (C1 esterase inhibitor [recombinant]) covered by Aetna CVS Health in Virginia requires prior authorization with specific lab documentation proving hereditary angioedema (HAE). Your fastest path: schedule an appointment with an HAE specialist (allergist/immunologist), gather your C1-INH and C4 lab results,

How to Get Procysbi (Cysteamine Bitartrate DR) Covered by Cigna in Virginia: Timeline, Appeals, and Step Therapy Guide

Answer Box: Getting Procysbi Covered by Cigna in Virginia Procysbi (cysteamine bitartrate DR) requires prior authorization from Cigna in Virginia, with standard review completed within one business day. Your fastest path: (1) Have your nephrologist or metabolic specialist gather diagnostic confirmation (genetic testing or elevated WBC cystine levels), (2) document

How to Get Carbaglu (Carglumic Acid) Covered by Humana in Virginia: Complete Appeals Guide

Answer Box: Getting Carbaglu Covered by Humana in Virginia Humana requires prior authorization for Carbaglu (carglumic acid) for NAGS deficiency treatment. In Virginia, you have strong appeal rights through the State Corporation Commission Bureau of Insurance. First steps: 1) Gather genetic confirmation of NAGS deficiency and elevated ammonia labs, 2)