Topic

Zolgensma (onasemnogene abeparvovec)

A collection of 28 issues

How to Get Zolgensma (onasemnogene abeparvovec) Covered by Aetna (CVS Health) in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by Aetna in Pennsylvania Aetna covers Zolgensma (onasemnogene abeparvovec) for spinal muscular atrophy under strict prior authorization requiring: confirmed bi-allelic SMN1 mutations, age under 24 months, anti-AAV9 antibody titer ≤1:50, and treatment at an approved gene therapy center. If denied, you have 180 days
6 min read

Getting Zolgensma (onasemnogene abeparvovec) Covered by Cigna in Pennsylvania: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Zolgensma Approved by Cigna in Pennsylvania Zolgensma requires prior authorization through Cigna's specialty pharmacy (Accredo) with strict eligibility criteria: genetic confirmation of SMA, patient under age 2, specialist prescription, and comprehensive clinical documentation. If denied, Pennsylvania's new external review process has a 53%
5 min read

How to Get Zolgensma Covered by UnitedHealthcare in Georgia: Prior Authorization, Appeals, and Alternative Strategies

Answer Box: Getting Zolgensma Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Zolgensma with strict medical criteria: genetic confirmation of bi-allelic SMN1 mutations, documentation of failed alternative treatments (Spinraza or Evrysdi), and prescriber expertise in SMA. If denied, you have 180 days for internal appeals and 60 days
6 min read

How to Get Zolgensma Covered by Cigna in New Jersey: Complete Guide to Prior Authorization, Appeals, and IHCAP External Review

Answer Box: Getting Zolgensma Covered by Cigna in New Jersey Cigna covers Zolgensma (onasemnogene abeparvovec) for children under 24 months with genetically confirmed spinal muscular atrophy (SMA) through prior authorization. The fastest path: (1) Gather genetic test results showing bi-allelic SMN1 mutations and anti-AAV9 antibody titer ≤1:50, (2) Submit
7 min read

If Zolgensma Isn't Approved by Blue Cross Blue Shield in North Carolina: Spinraza, Evrysdi & Exception Strategies

Answer Box: Your Next Steps When Zolgensma Is Denied If Blue Cross Blue Shield North Carolina denies Zolgensma (onasemnogene abeparvovec) for spinal muscular atrophy, you have proven alternatives: Spinraza (nusinersen) and Evrysdi (risdiplam) are both FDA-approved, disease-modifying SMA treatments typically covered on BCBS formularies. First step: Request your neurologist submit
6 min read

How to Get Zolgensma (Onasemnogene Abeparvovec) Covered by Aetna CVS Health in New Jersey: Complete Prior Authorization and Appeals Guide 2024

Answer Box: Getting Zolgensma Covered by Aetna CVS Health in New Jersey Eligibility: Patient must be under 24 months old with bi-allelic SMN1 mutations and anti-AAV9 antibody titer ≤1:50. Fastest path: Submit complete prior authorization through CVS Specialty (1-888-267-3277) with genetic testing, clinical documentation, and medical necessity letter addressing
5 min read