Topic

Virginia

A collection of 410 issues

Work With Your Doctor to Get Ruconest Covered by Aetna CVS Health in Virginia: Provider Collaboration Guide

Quick Answer: Your Path to Ruconest Coverage Getting Ruconest (C1 esterase inhibitor [recombinant]) covered by Aetna CVS Health in Virginia requires prior authorization with specific lab documentation proving hereditary angioedema (HAE). Your fastest path: schedule an appointment with an HAE specialist (allergist/immunologist), gather your C1-INH and C4 lab results,

How to Get Procysbi (Cysteamine Bitartrate DR) Covered by Cigna in Virginia: Timeline, Appeals, and Step Therapy Guide

Answer Box: Getting Procysbi Covered by Cigna in Virginia Procysbi (cysteamine bitartrate DR) requires prior authorization from Cigna in Virginia, with standard review completed within one business day. Your fastest path: (1) Have your nephrologist or metabolic specialist gather diagnostic confirmation (genetic testing or elevated WBC cystine levels), (2) document

How to Get Carbaglu (Carglumic Acid) Covered by Humana in Virginia: Complete Appeals Guide

Answer Box: Getting Carbaglu Covered by Humana in Virginia Humana requires prior authorization for Carbaglu (carglumic acid) for NAGS deficiency treatment. In Virginia, you have strong appeal rights through the State Corporation Commission Bureau of Insurance. First steps: 1) Gather genetic confirmation of NAGS deficiency and elevated ammonia labs, 2)

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