Topic

Virginia

A collection of 392 issues

Get Ilaris (Canakinumab) Covered by Cigna in Virginia: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Ilaris (Canakinumab) Covered by Cigna in Virginia Cigna covers Ilaris (canakinumab) for FDA-approved conditions like Still's disease and periodic fever syndromes under Policy IP0235, requiring prior authorization with specific criteria. To get approval in Virginia: 1. Gather documentation: CRP ≥10 mg/L (within 3 months)

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

Answer Box: Getting Oxlumo (lumasiran) Covered by Cigna in Virginia Myth: If your doctor prescribes Oxlumo, Cigna automatically covers it. Fact: Cigna requires prior authorization with genetic confirmation of Primary Hyperoxaluria Type 1 (PH1), elevated urinary oxalate levels, and specialist prescriber documentation. In Virginia, if denied, you have 180 days

The Complete Requirements Checklist to Get Sylvant (siltuximab) Covered by Blue Cross Blue Shield in Virginia

Answer Box: Getting Sylvant Covered by Blue Cross Blue Shield in Virginia Fastest Path to Approval: Anthem Blue Cross Blue Shield Virginia requires prior authorization for Sylvant (siltuximab) under clinical criteria CC-0113. You must prove HIV-negative and HHV-8-negative multicentric Castleman disease with supporting pathology and lab results. Submit through Anthem&

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

Quick Answer: To get Stelara (ustekinumab) covered by Cigna in Virginia, you'll need prior authorization showing failure of 2+ conventional therapies and specialist involvement. If denied, you have 180 days for internal appeals, then 120 days for Virginia's free external review through the State Corporation Commission.

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

Quick Answer: Getting Tepezza Approved by Cigna in Virginia Cigna requires prior authorization for Tepezza (teprotumumab) in Virginia. Your fastest path: Have your ophthalmologist or endocrinologist submit a PA request with documented moderate-to-severe thyroid eye disease (TED), including objective measurements and functional impact. If denied, you have 180 days to

Ultomiris (Ravulizumab) Approval with UnitedHealthcare in Virginia: Answers to the Most Common Questions

Answer Box: Getting Ultomiris Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Ultomiris (ravulizumab) with step therapy typically mandating prior eculizumab trial first. Submit PA via UnitedHealthcare provider portal with diagnosis confirmation, REMS vaccination records, and clinical rationale. Standard decisions take up to 72 hours; expedited reviews (when

How to Get Bylvay (odevixibat) Covered by Humana in Virginia: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Bylvay (odevixibat) Covered by Humana in Virginia Humana Medicare Advantage plans in Virginia typically cover Bylvay as a specialty Part D drug but require prior authorization. If denied, you have 65 days to file a Part D appeal (redetermination). Humana must respond within 7 days for standard

Do You Qualify for Symdeko/Symkevi Coverage by Aetna CVS Health in Virginia? Decision Tree & Next Steps

Quick Answer: Your Path to Symdeko/Symkevi Coverage in Virginia Eligibility: You likely qualify if you're ≥6 years old with cystic fibrosis and documented F508del mutations (homozygous or with another responsive mutation). Fastest approval: Have your CF specialist submit prior authorization with genotype report, clinic notes, and medical

How to Get Gilenya (fingolimod) Covered by UnitedHealthcare in Virginia: Appeal Templates & Timelines

Answer Box: Your Fastest Path to Gilenya Coverage UnitedHealthcare requires prior authorization for Gilenya (fingolimod) with step therapy requirements and safety documentation. If denied, you have 180 days to file an internal appeal, then 120 days for Virginia external review through the State Corporation Commission. Start today: 1) Request peer-to-peer

How to Get Tavalisse (Fostamatinib) Covered by Aetna CVS Health in Virginia: Complete Appeals Guide with Forms and Scripts

Answer Box: Fastest Path to Tavalisse Coverage To get Tavalisse (fostamatinib) covered by Aetna CVS Health in Virginia, you'll need prior authorization showing chronic ITP diagnosis, failed prior therapies (steroids, IVIG), and hematologist involvement. Submit PA via Availity provider portal with complete clinical documentation. If denied, you have