Topic

Virginia

A collection of 392 issues

Getting Signifor LAR (Pasireotide) Approved by Aetna in Virginia: Prior Authorization Guide and Appeal Process

Answer Box: Fast Track to Approval To get Signifor LAR (pasireotide) covered by Aetna in Virginia: Submit prior authorization with documented trial/failure of Somatuline Depot (lanreotide), elevated IGF-1 or cortisol labs, and surgical history via Aetna's precertification form. Appeals must be filed within 180 days, with Virginia

Work With Your Doctor to Get Arikayce Covered by UnitedHealthcare in Virginia: Complete Provider Partnership Guide

Answer Box: Your Path to Arikayce Coverage in Virginia UnitedHealthcare requires prior authorization for Arikayce (amikacin liposome inhalation) based on refractory MAC lung disease criteria: ≥6 months failed multidrug therapy with persistent positive cultures. Work with your pulmonologist or infectious disease specialist to document treatment failure, compile culture results, and

How to Get Revcovi (Elapegademase) Covered by Blue Cross Blue Shield in Virginia: Complete Prior Authorization & Appeals Guide

Quick Answer: Getting Revcovi Covered in Virginia Blue Cross Blue Shield (BCBS) in Virginia requires prior authorization for Revcovi (elapegademase) under medical benefit criteria for ADA-SCID treatment. The fastest path to approval: (1) Confirm your diagnosis with ICD-10 code D81.31 and ADA enzyme levels <1%, (2) Submit PA

How to Get Zanzalintinib (XL092) Covered by Humana in Virginia: Appeals Guide for Investigational Cancer Treatment

Answer Box: Getting Zanzalintinib (XL092) Coverage from Humana in Virginia Zanzalintinib (XL092) is investigational and typically denied by Humana as "not covered outside clinical trials." However, you have three main pathways: 1) Request a formulary exception with strong medical necessity documentation, 2) Apply for Exelixis' compassionate use

How to Get Naglazyme (Galsulfase) Covered by Cigna in Virginia: Complete Coding, Prior Authorization, and Appeals Guide

Quick Answer: Getting Naglazyme Covered by Cigna in Virginia Naglazyme (galsulfase) requires Cigna prior authorization with confirmed MPS VI diagnosis (ICD-10 E76.29), specialist prescription, and functional assessments. Submit using HCPCS J1458 (1 mg = 1 unit), include enzyme assay results and baseline 6-minute walk test. If denied, file internal appeal

Work With Your Doctor to Get Rebif (interferon beta-1a) Approved by Humana in Virginia

Quick Answer: Getting Rebif Covered by Humana in Virginia Humana requires prior authorization for Rebif (interferon beta-1a) across most plans, with step therapy often requiring trials of other MS therapies first. Your neurologist must submit clinical documentation including MS diagnosis, MRI results, prior treatment failures, and safety lab values. If

How to Get Arcalyst (Rilonacept) Covered by Humana in Virginia: Prior Authorization Forms, Appeal Process, and Resources

Answer Box: Getting Arcalyst (Rilonacept) Covered by Humana in Virginia Arcalyst (rilonacept) requires prior authorization from Humana for CAPS, DIRA, and recurrent pericarditis. Your fastest path: Have your prescriber submit a PA request with medical necessity documentation through Humana's provider portal or fax to 1-888-447 (verify current number)

Work With Your Doctor to Get Procysbi Approved by Blue Cross Blue Shield in Virginia: Forms, Appeals, and Provider Scripts

Answer Box: Getting Procysbi Covered in Virginia To get Procysbi (cysteamine bitartrate DR) approved by Blue Cross Blue Shield in Virginia: 1) Work with your doctor to document nephropathic cystinosis diagnosis with elevated WBC cystine levels (>2 nmol ½ cystine/mg protein), 2) Submit prior authorization showing failure/intolerance to

How to Get Idelvion (albutrepenonacog alfa) Covered by Cigna in Virginia: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Idelvion Covered by Cigna in Virginia Idelvion (albutrepenonacog alfa) requires prior authorization from Cigna/Express Scripts for Virginia patients with hemophilia B. Start by submitting through CoverMyMeds with complete clinical documentation including factor IX deficiency confirmation, inhibitor testing, and prior therapy history. If denied, file internal appeals

Myths vs. Facts: Getting Alecensa (alectinib) Covered by Blue Cross Blue Shield in Virginia

Answer Box: The Reality of Getting Alecensa Covered in Virginia Myth: If your oncologist prescribes Alecensa (alectinib), Blue Cross Blue Shield must cover it automatically. Fact: Anthem Blue Cross Blue Shield Virginia requires prior authorization for Alecensa, with specific ALK-positive NSCLC documentation and potential step therapy requirements. Most denials stem