Topic

Virginia

A collection of 471 issues

How to Get Voxzogo (vosoritide) Covered by Blue Cross Blue Shield in Virginia: Complete PA Guide with Forms and Appeal Process

Answer Box: Fast Track to Voxzogo Coverage in Virginia To get Voxzogo (vosoritide) covered by Blue Cross Blue Shield in Virginia: Submit prior authorization through Availity's Interactive Care Reviewer with genetic testing confirming FGFR3 achondroplasia, bone age X-ray showing open growth plates, 12+ months of growth data, and

How to Get Jakafi (Ruxolitinib) Covered by Humana in Virginia: Prior Authorization, Appeals, and ICD-10 Documentation Guide

Answer Box: Quick Path to Jakafi Coverage Humana covers Jakafi (ruxolitinib) on Tier 5 specialty for FDA-approved indications but requires prior authorization. Your hematologist/oncologist must submit documentation including confirmed diagnosis (ICD-10: D45 for polycythemia vera, D75.81 for myelofibrosis), failed prior therapies (especially hydroxyurea for PV), and recent labs.

Coding That Helps Get Poteligeo (mogamulizumab-kpkc) Approved by Aetna (CVS Health) in Virginia: ICD-10, HCPCS J-Code, and Prior Authorization Guide

Quick Answer: Getting Poteligeo (mogamulizumab-kpkc) Covered Poteligeo requires prior authorization from Aetna (CVS Health) for relapsed/refractory mycosis fungoides or Sézary syndrome. Use ICD-10 codes C84.0x (mycosis fungoides) or C84.1x (Sézary syndrome), HCPCS code J9204 (1 mg units), and document ≥1 prior systemic therapy failure. Submit via Aetna

How to Get Daybue (trofinetide) Covered by UnitedHealthcare in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Daybue (trofinetide) Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Daybue (trofinetide) with confirmed Rett syndrome diagnosis and patient age ≥2 years. Submit via the UHC provider portal with MECP2 genetic testing, specialist evaluation, and weight-based dosing calculation. If denied, file internal appeals within 180

Do You Qualify for Elzonris Coverage by Blue Cross Blue Shield in Virginia? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Elzonris Coverage in Virginia Yes, you can get Elzonris (tagraxofusp-erzs) covered by Blue Cross Blue Shield in Virginia if you have confirmed BPDCN (blastic plasmacytoid dendritic cell neoplasm), CD123-positive pathology, and serum albumin ≥3.2 g/dL. The fastest path: 1) Gather your biopsy

How to Get Natpara (Parathyroid Hormone) Covered by UnitedHealthcare in Virginia: 2025 Discontinuation Guide and Appeals Process

Answer Box: Quick Path to Coverage Natpara (parathyroid hormone) is no longer commercially available after Takeda's December 2024 discontinuation. UnitedHealthcare now denies new prescription requests, but existing patients in the Special Use Program may qualify for coverage through December 2025 with proper prior authorization. First step: Contact your

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

Answer Box: Get Tracleer Covered by Aetna (CVS Health) in Virginia Tracleer (bosentan) requires prior authorization on Aetna (CVS Health) plans and is typically non-formulary in 2025, requiring step therapy with preferred alternatives. To get coverage in Virginia: 1. Complete REMS enrollment for both patient and prescriber at BosentanREMSProgram.com

Hetlioz (Tasimelteon) Approval with Blue Cross Blue Shield in Virginia: Complete Coverage Guide

Quick Answer: Getting Hetlioz Covered by Blue Cross Blue Shield in Virginia Hetlioz (tasimelteon) requires prior authorization from Blue Cross Blue Shield Virginia (Anthem HealthKeepers) for Non-24-hour sleep-wake disorder and Smith-Magenis syndrome. Submit via Anthem's Interactive Care Reviewer (ICR) in Availity with sleep specialist documentation, diagnosis confirmation, and

Do You Qualify for Ozempic/Mounjaro Coverage by UnitedHealthcare in Virginia? Decision Tree & Next Steps

Answer Box: Quick Qualification Check Yes, you likely qualify for Ozempic/Mounjaro coverage by UnitedHealthcare in Virginia if you have: * Confirmed type 2 diabetes diagnosis (ICD-10 code E11.x) * Medical records documenting diabetes in your chart * A prescription from your doctor Fastest path to approval: Have your doctor submit prior

How to Get Kanuma (Sebelipase Alfa) Covered by Humana in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Kanuma Covered by Humana in Virginia Humana Medicare Advantage plans require prior authorization for Kanuma (sebelipase alfa) to treat LAL deficiency, with coverage requiring documented enzyme deficiency testing and clinical severity evidence. The fastest path: Have your prescriber submit a complete PA request through Humana's