Topic

Virginia

A collection of 470 issues

How Long Does It Take to Get Synagis (Palivizumab) Approved by Blue Cross Blue Shield in Virginia? Complete Timeline Guide

Answer Box: Synagis Approval Timeline in Virginia Blue Cross Blue Shield Virginia (Anthem) requires prior authorization for Synagis (palivizumab), typically taking 5-14 days for standard reviews. High-risk infants (≤35 weeks gestation, chronic lung disease, congenital heart disease) have the best approval odds when complete clinical documentation is submitted upfront. Start

How to Get Besponsa (inotuzumab ozogamicin) Covered by Aetna (CVS Health) in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Besponsa Covered in Virginia Aetna (CVS Health) requires prior authorization for Besponsa (inotuzumab ozogamicin) in Virginia. The fastest path to approval: 1) Confirm CD22-positive B-cell ALL with ≥5% blasts via flow cytometry, 2) Document relapsed/refractory status after ≥1 prior therapy, 3) Submit complete PA packet to

How to Get Taltz (Ixekizumab) Covered by Blue Cross Blue Shield in Virginia: Complete Coding, Prior Authorization, and Appeals Guide

Quick Answer: Blue Cross Blue Shield Virginia (Anthem BCBS) requires prior authorization for Taltz (ixekizumab), with step therapy mandating failure of TNF inhibitors. Submit PA via Availity Provider Portal with proper ICD-10 codes (L40.0 for plaque psoriasis), HCPCS J3590, and documented prior therapy failures. If denied, you have 180

Get Xospata (Gilteritinib) Covered by Cigna in Virginia: Provider Partnership Guide with Forms and Appeals

Answer Box: Fast Track to Xospata Coverage Xospata (gilteritinib) requires prior authorization from Cigna in Virginia for relapsed/refractory AML with confirmed FLT3 mutations. Your hematologist-oncologist must submit documentation through Express Scripts/Accredo or EviCore pathways. Key requirements: FLT3 mutation test results, prior therapy history, and medical necessity letter. Standard

How to Get Exondys 51 (Eteplirsen) Covered by Aetna CVS Health in Virginia: Complete Coding, Billing, and Appeals Guide

Answer Box: Getting Exondys 51 Covered by Aetna CVS Health in Virginia Exondys 51 (eteplirsen) requires prior authorization from Aetna CVS Health with specific coding and documentation. Use ICD-10 code G71.01 for Duchenne muscular dystrophy, HCPCS code J1428 for billing (10 mg units), and submit genetic testing confirming exon

How to Get Vanflyta (quizartinib) Covered by Humana in Virginia: Complete Coding, Appeals, and Prior Authorization Guide

Answer Box: Getting Vanflyta (quizartinib) Covered by Humana in Virginia Vanflyta (quizartinib) requires prior authorization on Humana Medicare Advantage plans in Virginia as a non-formulary specialty drug. Your fastest path: Have your oncologist submit PA documentation including FLT3-ITD lab results, baseline EKG, and medical necessity letter via Humana's

How to Get Voxzogo (vosoritide) Approved by UnitedHealthcare in Virginia: Complete Prior Authorization Guide

Answer Box: Getting Voxzogo Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Voxzogo (vosoritide) in children under 18 with confirmed achondroplasia and open growth plates. The fastest path: have your pediatric endocrinologist or geneticist submit the PA Medical Necessity form via the OptumRx Provider Portal with genetic testing

How to Get Luxturna (Voretigene Neparvovec-rzyl) Covered by Aetna CVS Health in Virginia: Complete Guide with Forms and Appeals

Answer Box: Getting Luxturna Covered by Aetna CVS Health in Virginia Luxturna requires prior authorization from Aetna CVS Health. You'll need confirmed biallelic RPE65 mutations via CLIA-certified genetic testing, proof of retinal viability (OCT showing ≥100 μm thickness), and treatment at an Aetna Institutes® GCIT Network facility. First

How Long Does It Take to Get Prolastin-C Approved by UnitedHealthcare in Virginia? Complete Timeline Guide

Quick Answer: Getting Prolastin-C approved by UnitedHealthcare in Virginia typically takes 5-7 business days for standard prior authorization or 72 hours for urgent requests. You'll need severe AAT deficiency documentation (Pi*ZZ genotype), emphysema proof via chest CT, and pulmonary function tests. If denied, Virginia gives you 120

How to Get Retevmo (Selpercatinib) Covered by UnitedHealthcare in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Retevmo Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Retevmo (selpercatinib) with RET alteration testing via FDA-approved diagnostics like FoundationOne CDx. The fastest path: (1) Gather RET fusion/mutation test results and complete pathology reports, (2) Submit PA through UnitedHealthcare Provider Portal with oncology consultation