Topic

Virginia

A collection of 470 issues

How to Get Onpattro (Patisiran) Covered by Humana in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Onpattro (Patisiran) Covered by Humana in Virginia Humana requires prior authorization for Onpattro (patisiran) with specific genetic and clinical documentation. Your fastest path to approval: (1) Have your neurologist submit genetic testing confirming a pathogenic TTR variant, (2) Include baseline mNIS+7 scores and functional assessment, (3)

How to Get Thiola / Thiola EC (tiopronin) Covered by Blue Cross Blue Shield Virginia: Timeline, Appeals & Documentation

Answer Box: Getting Thiola Covered by Blue Cross Blue Shield Virginia Blue Cross Blue Shield Virginia (Anthem) requires prior authorization for Thiola/Thiola EC (tiopronin) to treat cystinuria. The fastest path to approval involves submitting complete documentation including 24-hour urine cystine levels >500 mg/day, documented failure of alkalinization

Work With Your Doctor to Get Humira (adalimumab) Covered by Cigna in Virginia: Complete Provider Collaboration Guide

Answer Box: Getting Cigna to Cover Humira in Virginia To get Humira (adalimumab) covered by Cigna in Virginia, you'll need prior authorization with documented failure of preferred adalimumab biosimilars, clinical evidence of disease severity, and safety screenings. Your doctor submits the PA request; if denied, request peer-to-peer review

Getting Strimvelis Gene Therapy Covered by Humana in Virginia: Complete Timeline, Forms, and Appeals Guide

Answer Box: Fast Track to Strimvelis Coverage Getting Strimvelis covered by Humana in Virginia requires prior authorization with documented ADA enzyme deficiency (<1% normal), genetic confirmation of bi-allelic ADA mutations, and proof no suitable bone marrow donor exists. Submit via Humana's Clinical Pharmacy Review (800-555-2546) with medical

Myths vs. Facts: Getting Zolgensma (Onasemnogene Abeparvovec-xioi) Covered by Humana in Virginia

Quick Answer: Zolgensma (onasemnogene abeparvovec-xioi) requires prior authorization through Humana Medicare Advantage plans in Virginia, covered under Part B as an infused gene therapy. Success depends on genetic confirmation of SMN1 mutation, anti-AAV9 antibody titers ≤1:50, patient age under 2 years, and treatment at certified centers. If denied, Virginia&

How to Get Revcovi (elapegademase) Covered by Aetna CVS Health in Virginia: Complete PA Guide with Forms and Appeal Steps

Answer Box: Getting Revcovi Covered by Aetna CVS Health in Virginia Revcovi (elapegademase) requires prior authorization from Aetna CVS Health but is covered on the specialty tier for confirmed ADA-SCID cases. Submit a complete PA packet including genetic/enzyme testing, specialist documentation, and transplant failure evidence through the Aetna provider

Renewing Retevmo (Selpercatinib) Approval with Cigna in Virginia: Complete Renewal Guide and Timeline

Answer Box: Retevmo (Selpercatinib) Renewal with Cigna in Virginia Cigna requires prior authorization renewal for Retevmo (selpercatinib) every 12 months through Express Scripts/Accredo specialty pharmacy. Start your renewal 30-45 days before expiration with updated RET testing confirmation, disease status imaging, treatment response documentation, and an oncologist necessity letter citing

How to Get Berinert (C1-Esterase Inhibitor) Approved by Cigna in Virginia: Complete PA Guide with Appeal Scripts

Quick Answer: Getting Berinert Approved by Cigna in Virginia Cigna requires prior authorization for Berinert (C1-esterase inhibitor, IV) through Express Scripts, with confirmed HAE diagnosis via low C1-INH and C4 levels, specialist prescription, and documented attack history. In Virginia, if denied, you have 180 days to appeal internally, then 120

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

Answer Box: Getting Jakafi Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Jakafi (ruxolitinib) as a Tier 6 specialty medication. For myelofibrosis, you need intermediate/high-risk classification (DIPSS score ≥1) or symptomatic splenomegaly with anemia. For polycythemia vera, you must document hydroxyurea failure, inadequate response, or intolerance first.

How to Get Blenrep (Belantamab Mafodotin) Covered by Blue Cross Blue Shield in Virginia: Current Access Options and Appeals Guide

Answer Box: Blenrep Coverage in Virginia Blenrep (belantamab mafodotin) is not commercially available in the U.S. as of 2025 due to GSK's voluntary withdrawal in 2022 pending FDA resubmission (PDUFA target October 2025). Current access is limited to clinical trials or expanded access programs only. For Blue