Topic

Virginia

A collection of 47 issues

Get Fabrazyme (Agalsidase Beta) Covered by Humana in Virginia: Complete Guide to Prior Authorization, Appeals, and Success Strategies

Quick Answer: To get Fabrazyme (agalsidase beta) covered by Humana in Virginia, you need prior authorization with genetic confirmation of Fabry disease, a specialist prescription, and complete clinical documentation. Submit through Humana's provider portal with HCPCS code J0180. If denied, you have 65 days to appeal, followed by

Getting Pyrukynd (Mitapivat) Covered by Humana in Virginia: Prior Authorization to Appeals

Quick Answer: To get Pyrukynd (mitapivat) covered by Humana in Virginia, you'll need prior authorization with genetic testing confirming pyruvate kinase deficiency, hemoglobin ≤10 g/dL, transfusion history documentation, and a hematologist's letter. If denied, you have 65 days to appeal through Humana, then 120 days

Getting Strimvelis Gene Therapy Covered by Cigna in Virginia: Complete Decision Tree and Appeals Guide

Answer Box: Your Path to Strimvelis Coverage Strimvelis eligibility requires confirmed ADA-SCID diagnosis via genetic testing and enzyme levels, plus documentation that no suitable matched donor is available. Since Strimvelis is only administered at SR-TIGET in Milan, you'll need Cigna's out-of-network international coverage approval. First step

The Requirements Checklist to Get Lumizyme (Alglucosidase Alfa) Covered by UnitedHealthcare in Virginia: Forms, Appeals, and Clinical Criteria

Answer Box: Getting Lumizyme Covered by UnitedHealthcare in Virginia Eligibility: Confirmed Pompe disease with genetic testing and enzyme deficiency. Fastest path: Submit prior authorization through UnitedHealthcare Provider Portal with complete diagnostic workup. First step today: Verify your plan's formulary status and gather enzyme activity results plus GAA gene

Get Pemazyre (Pemigatinib) Covered by Anthem Blue Cross Blue Shield Virginia: Forms, Appeals & Prior Authorization Guide

Answer Box: Getting Pemazyre (Pemigatinib) Covered in Virginia Pemazyre (pemigatinib) requires prior authorization from Anthem Blue Cross Blue Shield Virginia for cholangiocarcinoma with FGFR2 fusion. The fastest path: (1) Have your oncologist submit the PA request through Availity's Interactive Care Reviewer portal with FGFR2 testing results and prior

How to Get Dojolvi (triheptanoin) Covered by Cigna in Virginia: Complete Appeals Guide

Answer Box: Getting Dojolvi (triheptanoin) Covered by Cigna in Virginia Cigna requires prior authorization for Dojolvi with molecular confirmation of long-chain fatty acid oxidation disorder (LC-FAOD). Submit through CoverMyMeds or ExpressPAth with genetic test results, diagnosis codes, and clinical rationale. If denied, Virginia law provides step therapy override protections and

How to Get Carbaglu (Carglumic Acid) Covered by Aetna CVS Health in Virginia: Appeals Guide and Templates

Answer Box: Fast Track to Carbaglu Coverage Carbaglu (carglumic acid) is covered by Aetna CVS Health in Virginia for FDA-approved NAGS deficiency with prior authorization. To get approved: 1. Submit PA request with genetic/biochemical confirmation of NAGS deficiency plus elevated plasma ammonia labs 2. If denied, file internal appeal

Renewing Amvuttra (Vutrisiran) Coverage with Aetna CVS Health in Virginia: Documentation, Timelines & Appeal Rights

Answer Box: Renewing Amvuttra (vutrisiran) with Aetna CVS Health in Virginia requires annual documentation showing continued benefit and meeting original criteria. Submit renewal 30 days before expiration with updated clinical notes, labs (sTTR, NT-proBNP), cardiac function tests, and evidence of treatment response. If denied, Virginia's Bureau of Insurance

How to Get Cabometyx (Cabozantinib) Covered by Aetna CVS Health in Virginia: PA Requirements, Appeal Process & Forms

Answer Box: Getting Cabometyx Covered by Aetna CVS Health in Virginia Key Challenge: Cabometyx (cabozantinib) is excluded from Aetna's 2024 Advanced Control formulary, meaning standard coverage is denied. However, Virginia patients can pursue a formulary exception through Aetna's medical necessity process. Fastest Path to Approval: 1.

Getting Pyrukynd (Mitapivat) Covered by Aetna CVS Health in Virginia: Complete Guide to Prior Authorization and Appeals

Answer Box: Your Path to Pyrukynd Coverage Getting Pyrukynd (mitapivat) covered by Aetna CVS Health in Virginia requires prior authorization with strict genetic and clinical criteria. You'll need confirmed pyruvate kinase deficiency with at least two PKLR gene variants (one missense), hemoglobin ≤10 g/dL or significant transfusion