Topic

Virginia

A collection of 392 issues

How to Get Sylvant (siltuximab) Covered by Cigna in Virginia: Appeals Process, Forms, and Medical Necessity Templates

Quick Answer: Getting Sylvant (siltuximab) Covered by Cigna in Virginia Cigna requires prior authorization for Sylvant (siltuximab) using their specific PA form, which must document HIV-negative and HHV-8-negative status for multicentric Castleman disease. If denied, you have 180 days to appeal internally, then 120 days to file external review with

How to Get Luxturna Covered by UnitedHealthcare in Virginia: Complete Forms Guide and Appeal Process

Answer Box: Getting Luxturna Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Luxturna through OptumRx, with strict criteria including confirmed biallelic RPE65 mutations and retinal viability testing. Start today: (1) Verify your plan uses OptumRx for specialty drugs, (2) obtain CLIA-certified genetic testing showing biallelic RPE65 mutations, and

Get Tecentriq (Atezolizumab) Covered by Humana in Virginia: Complete Prior Authorization & Appeals Guide

Answer Box: Quick Path to Coverage Tecentriq (atezolizumab) requires prior authorization from Humana and must be dispensed through specialty pharmacies like CenterWell. In Virginia, if denied, you have 65 days to appeal and can request expedited external review through the State Corporation Commission if delays risk serious harm. First steps

Myths vs. Facts: Getting Orfadin (nitisinone) Covered by Aetna (CVS Health) in Virginia

Quick Answer: Aetna (CVS Health) requires prior authorization for Orfadin (nitisinone) with documented HT-1 diagnosis via elevated succinylacetone, dietary management plan, and weight-based dosing justification. Appeals must be filed within 180 days, with Virginia's external review available through the State Corporation Commission. Start by gathering lab results, genetic

How Long Does It Take to Get Eloctate Approved by Humana in Virginia? Complete Timeline Guide

Answer Box: Getting Eloctate Approved by Humana in Virginia Standard timeline: 1-7 days for complete prior authorization requests submitted electronically. Humana processes 95% of electronic PAs within 1 business day, with a maximum of 7 calendar days per CMS rules. Fastest path: Have your hematologist submit complete documentation via Humana&

How to Get Zokinvy (lonafarnib) Covered by UnitedHealthcare in Virginia: Complete PA Guide with Appeal Scripts

Answer Box: Getting Zokinvy Covered by UnitedHealthcare in Virginia Zokinvy (lonafarnib) requires prior authorization from UnitedHealthcare and is typically non-formulary, requiring a coverage exception. The fastest path: 1) Submit PA through the UHC Provider Portal with genetic confirmation of HGPS/progeroid laminopathy, 2) Include medical necessity letter citing FDA approval

How to Get Carbaglu (Carglumic Acid) Covered by Blue Cross Blue Shield in Virginia: Complete Prior Authorization Guide

Answer Box: Getting Carbaglu Covered by BCBS Virginia Carbaglu (carglumic acid) requires prior authorization from Anthem Blue Cross Blue Shield Virginia for NAGS deficiency. Your fastest path to approval: 1) Verify your plan's formulary status at Anthem's Virginia drug list page, 2) Submit PA with genetic

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

Answer Box: Getting Gilenya (fingolimod) Covered by Humana in Virginia Gilenya (fingolimod) requires prior authorization from Humana with documentation of MS diagnosis, cardiac monitoring plan, ophthalmology exam, and vaccination status. If denied, you have 65 days to appeal through Humana's internal process, followed by Virginia's external

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

Answer Box: Getting Opfolda Covered by Aetna CVS Health in Virginia Opfolda (miglustat) requires prior authorization from Aetna CVS Health and must be prescribed with Pombiliti for adults (≥18 years, ≥40 kg) with late-onset Pompe disease who aren't improving on current enzyme replacement therapy. Submit requests via Aetna&

Getting Ocrevus (Ocrelizumab) Covered by Blue Cross Blue Shield in Virginia: PA Requirements, Appeals, and Success Strategies

Answer Box: Quick Path to Coverage To get Ocrevus (ocrelizumab) covered by Blue Cross Blue Shield in Virginia: Complete the specific Ocrevus PA form with all required checkboxes, including confirmed MS diagnosis, hepatitis B screening results, and step therapy documentation. Fax to 844-512-7020 with supporting MRI reports and clinical notes.