Topic

Virginia

A collection of 237 issues

Aetna (CVS Health)'s Coverage Criteria for Pemazyre (pemigatinib) in Virginia: What Counts as "Medically Necessary"?

Quick Answer: Getting Pemazyre (pemigatinib) Covered by Aetna (CVS Health) in Virginia Pemazyre requires prior authorization from Aetna (CVS Health) and is typically non-formulary, requiring a formulary exception. The fastest path to approval: (1) Submit complete documentation including positive FGFR2/FGFR1 molecular test results, prior therapy history, and baseline ophthalmologic

Renewing Vimizim (Elosulfase Alfa) Coverage with Humana in Virginia: Complete Guide to Timelines, Documentation, and Appeals

Answer Box: Fast Track to Vimizim Renewal Humana requires prior authorization renewal for Vimizim (elosulfase alfa) in Virginia with specific documentation proving ongoing medical necessity. Start your renewal 2-4 weeks before expiration to avoid treatment gaps. Submit updated clinical assessments (6-minute walk test, pulmonary function), chart notes showing therapeutic response,

Get Eloctate Covered by Aetna CVS Health in Virginia: Complete Guide to Prior Authorization, Appeals, and Approval

Answer Box: Quick Path to Eloctate Coverage Eloctate is covered by Aetna CVS Health in Virginia as a preferred specialty drug requiring prior authorization. Your hematologist must submit clinical documentation through Aetna's provider portal, including hemophilia A diagnosis, bleeding history, and dosing rationale. Standard decisions take 30-45 days;

Getting Ozempic and Mounjaro Covered by Humana in Virginia: Prior Authorization, Appeals, and Step-by-Step Guide

Quick Answer: Getting Humana to Cover Ozempic or Mounjaro in Virginia Yes, Humana covers Ozempic and Mounjaro for type 2 diabetes, but requires prior authorization and step therapy (trying metformin first). Your fastest path: 1) Have your doctor document failed metformin trial and current A1c >7%, 2) Submit PA

Work With Your Doctor to Get Tegsedi (inotersen) Approved by UnitedHealthcare in Virginia: Complete Prior Authorization Guide

Quick Answer: Getting Tegsedi (inotersen) covered by UnitedHealthcare in Virginia requires genetic confirmation of hATTR polyneuropathy, REMS program enrollment, and documented failure of Onpattro (step therapy). Start by scheduling a visit with your neurologist to review diagnostic requirements and gather clinical documentation. If denied, Virginia's Bureau of Insurance

How to Get Gattex (Teduglutide) Covered by UnitedHealthcare in Virginia: Appeals, Forms, and Provider Scripts

Answer Box: Getting Gattex Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Gattex (teduglutide) with specific medical necessity criteria. Patients need documented Short Bowel Syndrome, current parenteral nutrition dependency (≥12 months for adults, ≥3 months for pediatrics), and recent colonoscopy results. If denied, Virginia offers a robust external

If Tegsedi (Inotersen) Isn't Approved by Aetna CVS Health in Virginia: Formulary Alternatives & Exception Paths

Answer Box: Your Path Forward When Tegsedi Is Denied If Aetna CVS Health denies Tegsedi (inotersen) in Virginia, you have clear alternatives and appeal options. Onpattro (patisiran) is typically the required first-line treatment under Aetna's step therapy policy. After documented failure or intolerance to Onpattro, you can request

How Long Does It Take to Get Trikafta Approved by Cigna in Virginia? Complete Timeline and Appeals Guide

Answer Box: Getting Trikafta Approved by Cigna in Virginia Standard Cigna prior authorization for Trikafta takes up to 5 business days in Virginia, or 2 calendar days for expedited requests. You'll need F508del mutation documentation, CF specialist prescription, and complete clinical records. If denied, you have 180 days

How to Get Entresto (Sacubitril/Valsartan) Covered by Cigna in Virginia: Forms, Appeals, and Step Therapy Rights

Answer Box: Getting Entresto Covered by Cigna in Virginia Entresto (sacubitril/valsartan) requires prior authorization from Cigna, with step therapy requiring documented ACE inhibitor or ARB trial failure. Submit your PA request via CoverMyMeds or fax to 1-866-873-8279 with heart failure diagnosis, LVEF results, and medication history. If denied, file

How to Get Zanzalintinib (XL092) Covered by Aetna CVS Health in Virginia: Appeals, Forms & Timelines

Answer Box: Getting Zanzalintinib (XL092) Covered by Aetna CVS Health in Virginia Zanzalintinib (XL092) is investigational and typically denied by Aetna CVS Health unless part of a clinical trial or compassionate use program. Your fastest path: 1) Have your doctor request a formulary exception with detailed medical necessity documentation, 2)