Topic

Virginia

A collection of 238 issues

Pombiliti (cipaglucosidase alfa-atga) Approval with Aetna (CVS Health) in Virginia: Answers to the Most Common Questions

Answer Box: Getting Pombiliti Covered by Aetna in Virginia Yes, Pombiliti (cipaglucosidase alfa-atga) plus Opfolda can be covered by Aetna (CVS Health) in Virginia for adults with late-onset Pompe disease who meet FDA criteria and aren't improving on current ERT. Fastest path: Have your specialist submit prior authorization

How to Get Kymriah (tisagenlecleucel) Covered by Blue Cross Blue Shield in Virginia: Decision Tree, Appeals, and Next Steps

Answer Box: Getting Kymriah Coverage in Virginia Kymriah (tisagenlecleucel) requires prior authorization from all Blue Cross Blue Shield plans in Virginia as of July 2024. Your fastest path to approval: (1) Confirm treatment at a BCBS-certified CAR-T center, (2) Have your oncologist submit comprehensive clinical documentation through Anthem's

How to Get Elaprase (Idursulfase) Covered by Aetna CVS Health in Virginia: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Elaprase (Idursulfase) Covered by Aetna CVS Health in Virginia Aetna CVS Health requires prior authorization for Elaprase (idursulfase) with strict documentation: confirmed MPS II diagnosis via enzyme assay or genetic testing, specialist prescriber, and weight-based dosing calculations. Coverage typically limits hospital infusion to 45 days, favoring home

How to Get Onpattro (Patisiran) Covered by Blue Cross Blue Shield in Virginia: Complete Coding, Appeals & Timeline Guide

Answer Box: Getting Onpattro Covered in Virginia Blue Cross Blue Shield (Anthem) in Virginia requires prior authorization for Onpattro (patisiran) under the medical benefit using HCPCS J0222. Success depends on proper coding (ICD-10 E85.1), genetic confirmation of TTR mutation, and neurologist evaluation. If denied, Virginia's State Corporation

Myths vs. Facts: Getting Rezlidhia (olutasidenib) Covered by Cigna in Virginia - Complete Appeals Guide

Answer Box: Getting Rezlidhia (olutasidenib) Covered by Cigna in Virginia Eligibility: Adults with relapsed/refractory AML and documented IDH1 mutation via FDA-approved test. Fastest path: Have your oncologist submit complete prior authorization with IDH1 test results, treatment history, and medical necessity letter referencing NCCN guidelines. First step today: Call Cigna

How to Get Photrexa (Riboflavin) Covered by Cigna in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Photrexa Covered by Cigna in Virginia Cigna requires prior authorization for Photrexa (riboflavin ophthalmic solution) used in corneal cross-linking for keratoconus in Virginia. Your ophthalmologist must document progressive disease with serial corneal topography showing ≥1.0 diopter increase in maximum keratometry (Kmax) and failed conservative treatments. Submit

Do You Qualify for Hetlioz (Tasimelteon) Coverage by UnitedHealthcare in Virginia? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Hetlioz Coverage To get Hetlioz (tasimelteon) covered by UnitedHealthcare in Virginia, you must have a confirmed diagnosis of Non-24-Hour Sleep-Wake Disorder (with total blindness) or Smith-Magenis Syndrome, plus documented failure of melatonin therapy. The fastest approval path: (1) Have your sleep specialist complete UnitedHealthcare&

How to Get Keytruda (Pembrolizumab) Approved by Aetna CVS Health in Virginia: Complete Guide to Prior Authorization, Appeals, and Billing

Answer Box: Getting Keytruda Covered by Aetna CVS Health in Virginia Prior authorization is required for Keytruda (pembrolizumab) through Aetna CVS Health. Submit your request with complete clinical documentation including PD-L1 test results, pathology reports, and prior therapy records. If denied, Virginia's State Corporation Commission provides external review

Get Elevidys Gene Therapy Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Elevidys Covered by Aetna CVS Health in Virginia Eligibility: Aetna covers Elevidys for DMD patients age 4+ with confirmed genetic mutation (excluding exon 8/9 deletions), anti-AAVrh74 antibodies <1:400, and normal liver function. Fastest path: Submit prior authorization via Availity.com with complete documentation to

Get Elzonris (Tagraxofusp) Covered by Humana in Virginia: Complete PA Guide

Quick Answer: Getting Elzonris Covered by Humana in Virginia To get Elzonris (tagraxofusp-erzs) approved by Humana in Virginia, you need: (1) confirmed BPDCN diagnosis with CD123-positive pathology, (2) serum albumin ≥3.2 g/dL, (3) capillary leak syndrome monitoring plan, and (4) oncologist prescriber. Submit prior authorization through Humana'