Topic

Zolgensma (onasemnogene abeparvovec-xioi)

A collection of 21 issues

How to Get Zolgensma Covered by Cigna in Texas: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Zolgensma Covered by Cigna in Texas Cigna requires prior authorization for Zolgensma (onasemnogene abeparvovec-xioi) via Express Scripts/Accredo for children under 2 with spinal muscular atrophy. Key requirements: bi-allelic SMN1 gene mutations, anti-AAV9 antibody titer ≤1:50, recent labs, and treatment at a certified site. If denied,

Myths vs. Facts: Getting Zolgensma Covered by Blue Cross Blue Shield of Texas (2025 Guide)

Answer Box: The Truth About Zolgensma Coverage in Texas Fact: Blue Cross Blue Shield of Texas (BCBSTX) covers Zolgensma for eligible SMA patients when strict medical criteria are met. Your fastest path: Have your pediatric neurologist submit prior authorization with complete genetic testing (bi-allelic SMN1 mutation), anti-AAV9 antibody titer ≤1:

How to Get Zolgensma Covered by Aetna CVS Health in Ohio: Complete Prior Authorization and Appeals Guide 2024

Quick Answer: Getting Zolgensma Covered by Aetna CVS Health in Ohio Aetna CVS Health requires prior authorization for Zolgensma in Ohio with strict criteria: patient under 24 months, confirmed bi-allelic SMN1 mutations, anti-AAV9 antibody titer ≤1:50, and treatment at a certified gene therapy center. Submit the Zolgensma Medication Precertification

How to Get Zolgensma (onasemnogene abeparvovec-xioi) Covered by Humana in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by Humana in New Jersey Zolgensma (onasemnogene abeparvovec-xioi) requires prior authorization from Humana Medicare Advantage plans in New Jersey as a high-cost specialty gene therapy (HCPCS J3399). Coverage requires genetic confirmation of SMA with SMN1 mutation, age under 2 years, negative AAV9 antibody titers, and

How to Get Zolgensma Covered by Humana in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by Humana in Georgia Fastest path: Submit prior authorization through Humana's medical benefit using HCPCS J3399 with complete genetic testing (SMN1 mutation confirmation), AAV9 antibody results, and specialist letter of medical necessity. Standard decision within 14-30 days; expedited within 72 hours if delay

How to Get Zolgensma Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Zolgensma Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization through OptumRx for Zolgensma (onasemnogene abeparvovec-xioi) with strict clinical criteria: genetic confirmation of bi-allelic SMN1 mutations, age under 2 years, anti-AAV9 antibody titer ≤1:50, and documented steroid protocol. If denied, North Carolina residents can appeal

How to Get Zolgensma (onasemnogene abeparvovec-xioi) Covered by Humana in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by Humana in Michigan Zolgensma requires prior authorization from all Humana plans in Michigan. For Medicare Advantage members, submit via Humana's medical benefit PA process using HCPCS J3399. Commercial members use pharmacy benefit channels. Key requirements: genetic confirmation of SMA, age/weight within

Work With Your Doctor to Get Zolgensma Covered by UnitedHealthcare in Washington: Prior Authorization, Appeals, and Documentation Guide

Answer Box: Get Zolgensma Covered by UnitedHealthcare in Washington Fastest path: Partner with your pediatric neurologist to submit a complete prior authorization including genetic confirmation of bi-allelic SMN1 mutation, anti-AAV9 antibody titer ≤1:50, and detailed medical necessity letter. UnitedHealthcare requires PA for all Zolgensma cases with 45-day authorization window

How to Get Zolgensma Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by Blue Cross Blue Shield in New York Yes, Blue Cross Blue Shield plans in New York do cover Zolgensma for eligible children with spinal muscular atrophy (SMA). The fastest path to approval requires three key steps: 1) Confirm genetic testing shows bi-allelic SMN1 mutation

Get Zolgensma Covered by Humana in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by Humana in Washington Fastest Path: Submit prior authorization through Humana's provider portal with genetic testing, neurologist letter, and baseline labs. If denied, you have 65 days for internal appeal and 180 days for external review through Washington's Independent Review Organization.