Topic

Virginia

A collection of 471 issues

How to Get Filsuvez (Birch Triterpenes Gel) Covered by Blue Cross Blue Shield in Virginia: Complete PA Guide and Appeals Process

Answer Box: Getting Filsuvez Covered by Blue Cross Blue Shield in Virginia Filsuvez (birch triterpenes topical gel) requires prior authorization from Blue Cross Blue Shield in Virginia for epidermolysis bullosa (EB) wound care. Submit PA via your provider with genetic testing confirming dystrophic or junctional EB, wound documentation ≥20 cm²

How to Get Tagrisso (Osimertinib) Covered by Cigna in Virginia: Prior Authorization Guide and Appeal Timeline

Quick Answer: To get Tagrisso (osimertinib) covered by Cigna in Virginia, you need prior authorization with documented EGFR mutation testing and clinical justification. Submit through Cigna's provider portal with oncology notes, pathology reports, and treatment history. Standard approval takes 72 hours; if denied, Virginia's Bureau of

How to Get Lamzede (velmanase alfa-tycv) Covered by UnitedHealthcare in Virginia: Complete PA Guide and Appeals Process

Quick Answer: Getting Lamzede Covered by UnitedHealthcare in Virginia Lamzede (velmanase alfa-tycv) requires prior authorization through OptumRx for UnitedHealthcare pharmacy benefits. Submit your request via CoverMyMeds electronic PA with confirmed alpha-mannosidosis diagnosis (enzyme activity <10% normal, ICD-10 E77.1), genetic testing showing biallelic MAN2B1 variants, and documentation of non-CNS

How to Get Elevidys Covered by Humana in Virginia: Complete Prior Authorization Guide with Forms and Appeal Scripts

Answer Box: Getting Elevidys Covered by Humana in Virginia Elevidys (delandistrogene moxeparvovec-rokl) requires prior authorization from Humana for ambulatory DMD patients aged 4+ with confirmed genetic mutations. First step: Verify your plan type (Medicare Advantage vs. Part D) and contact a certified DMD center in Virginia. Fastest path: Submit PA

Get Rylaze Covered by Humana in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Rylaze Covered by Humana in Virginia Yes, Humana covers Rylaze (asparaginase erwinia chrysanthemi [recombinant]-rywn) with prior authorization for patients ≥1 month with ALL/LBL who've had Grade 2+ hypersensitivity reactions to E. coli asparaginase. Your oncologist submits the PA through Humana's provider

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

Answer Box: Getting Rapivab Covered by Humana in Virginia Rapivab (peramivir) requires prior authorization from Humana in Virginia. Your fastest path to approval: (1) Confirm symptom onset ≤48 hours with positive flu test, (2) Document why oral antivirals (oseltamivir/zanamivir) can't be used, and (3) Submit via Humana&

How to Renew Brensocatib (BRINSUPRI) Approval with Humana in Virginia: 2025 Timeline & Required Documentation

Answer Box: Renewing Brensocatib (BRINSUPRI) with Humana in Virginia Brensocatib (BRINSUPRI) renewal with Humana typically requires submission 30-60 days before your current authorization expires. Key requirements: documented adherence ≥85%, clinical response evidence (reduced exacerbations, stable/improved FEV1), and prescriber attestation of continued medical necessity. Submit renewal requests via Humana'

How to Get Vyondys 53 (Golodirsen) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Vyondys 53 Covered by Aetna CVS Health in Virginia Eligibility: Patients with confirmed Duchenne muscular dystrophy (DMD) and a genetic mutation amenable to exon 53 skipping. Fastest approval path: Submit prior authorization through your DMD specialist with genetic testing, baseline assessments, and corticosteroid documentation. Start today: Contact

Myths vs. Facts: Getting Tagrisso (osimertinib) Covered by Aetna (CVS Health) in Virginia

Answer Box: Getting Tagrisso (osimertinib) Covered by Aetna (CVS Health) in Virginia Aetna (CVS Health) requires prior authorization for all Tagrisso prescriptions, mandating documented EGFR mutation testing and oncology specialist prescriber. Standard review takes 30-45 days; expedited appeals (with physician urgency statement) complete within 72 hours. If denied, Virginia'

How to Get Hemlibra (Emicizumab) Covered by UnitedHealthcare in Virginia: Complete PA Guide, Appeals, and Templates

Answer Box: Quick Path to Hemlibra Coverage in Virginia UnitedHealthcare requires prior authorization for all Hemlibra (emicizumab-kxwh) prescriptions. For hemophilia A patients with factor VIII inhibitors ≥5 Bethesda units, there's no step therapy requirement. Submit PA through the UnitedHealthcare Provider Portal with complete clinical documentation including inhibitor titers,