Topic

Virginia

A collection of 409 issues

How Long Does It Take to Get Natpara (Parathyroid Hormone) Approved by Aetna CVS Health in Virginia? Timeline & Appeal Guide

Quick Answer: Natpara (parathyroid hormone) is currently unavailable for new prescriptions through Aetna CVS Health as Takeda discontinued manufacturing in 2024. Existing patients on the Special Use Program have access until December 31, 2025. For hypoparathyroidism treatment, work with your endocrinologist to request formulary exceptions for alternative therapies like high-dose

Renewing Onivyde (Irinotecan Liposome) Approval with Blue Cross Blue Shield in Virginia: Annual Review Requirements and Timeline

Answer Box: Renewing Your Onivyde Coverage Anthem Blue Cross Blue Shield Virginia requires annual prior authorization renewal for Onivyde (irinotecan liposome). Start the renewal process 30-45 days before your current authorization expires to avoid treatment interruptions. Your oncologist must submit updated clinical documentation through Availity Essentials showing continued medical necessity,

How to Get Dojolvi (triheptanoin) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Dojolvi Covered by Aetna CVS Health in Virginia Dojolvi (triheptanoin) requires prior authorization and formulary exception from Aetna CVS Health. You'll need molecular confirmation of long-chain fatty acid oxidation disorder (LC-FAOD), specialist prescription, and documentation that other MCT products have been discontinued. The fastest path:

Getting Symdeko (Tezacaftor/Ivacaftor) Covered by UnitedHealthcare in Virginia: Complete Prior Authorization Guide

Answer Box: Your Path to Symdeko Coverage in Virginia Symdeko (tezacaftor/ivacaftor) requires prior authorization from UnitedHealthcare, with specific genotype documentation and specialist requirements. The fastest path: 1) Confirm F508del mutation status via FDA-cleared testing, 2) Have your CF specialist submit UnitedHealthcare's Symdeko Prior Authorization form with complete

If Poteligeo Isn't Approved by UnitedHealthcare in Virginia: Formulary Alternatives & Exception Paths

Answer Box If UnitedHealthcare denies Poteligeo (mogamulizumab-kpkc) for mycosis fungoides or Sézary syndrome in Virginia, you have two paths: try required formulary alternatives first (romidepsin, vorinostat, brentuximab vedotin) or request a step therapy exception with strong clinical documentation. If denied, Virginia's Bureau of Insurance offers external review within

Do You Qualify for Idelvion Coverage by Humana in Virginia? Decision Tree & Next Steps

Quick Answer: Your Path to Idelvion Coverage If you have hemophilia B and Humana coverage in Virginia, you likely qualify for Idelvion (albutrepenonacog alfa) coverage. The fastest path: confirm your factor IX deficiency diagnosis with lab results, gather documentation of bleeding episodes or prophylaxis needs, and have your hematologist submit

Myths vs. Facts: Getting Lutathera (Lutetium Lu-177 Dotatate) Covered by Aetna CVS Health in Virginia

Answer Box: Lutathera Coverage by Aetna CVS Health in Virginia Eligibility: Adults and pediatric patients ≥12 years with SSTR-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs) that are unresectable, locally advanced, or metastatic. Fastest Path: Submit prior authorization through Aetna provider portal with complete documentation: pathology report, SSTR-positive imaging (Ga-68 DOTATATE PET), prior

Get Elevidys Covered by UnitedHealthcare in Virginia: Complete Guide to Prior Authorization, Appeals, and State External Review

Answer Box: Getting Elevidys Covered by UnitedHealthcare in Virginia Elevidys requires prior authorization from UnitedHealthcare and must be dispensed through designated specialty pharmacies like Accredo or CVS Specialty. First step: Have your neurologist submit a PA request with DMD genetic confirmation, anti-AAVrh74 antibody titer ≤1:400, and detailed medical necessity

Getting Xywav (Ca/Mg/K/Na Oxybates) Covered by UnitedHealthcare in Virginia: Complete ICD-10, NDC, and Appeal Guide

Quick Answer: UnitedHealthcare requires prior authorization for Xywav (Ca/Mg/K/Na oxybates) in Virginia. You need REMS enrollment, documented step therapy failures, and specific ICD-10 codes (G47.41 for narcolepsy with cataplexy, G47.11 for idiopathic hypersomnia). Submit via OptumRx with sleep studies and failed alternative documentation. If denied,

If Cerezyme (Imiglucerase) Isn't Approved by Blue Cross Blue Shield in Virginia: Formulary Alternatives & Exception Paths

Answer Box If Blue Cross Blue Shield Virginia denies Cerezyme (imiglucerase) for Gaucher disease, you have three main paths: request a formulary exception with medical necessity documentation, consider FDA-approved alternatives like VPRIV or Elelyso if covered, or pursue Virginia's external review process through the State Corporation Commission. Start