Topic

Washington

A collection of 233 issues

How to Get Taltz (Ixekizumab) Covered by Cigna in Washington: Prior Authorization Forms, Appeal Process, and Coding Requirements

Quick Answer: Cigna requires prior authorization for Taltz (ixekizumab) in Washington, typically mandating documented failure of a TNF inhibitor first. Submit PA requests via CoverMyMeds or Cigna's provider portal with complete medical records. If denied, you have 180 days for internal appeals, then can request external review through

How to Get Hetlioz LQ Covered by Humana in Washington: Prior Authorization Forms, Appeals, and Coding Guide

Answer Box: Getting Hetlioz LQ Covered by Humana in Washington Hetlioz LQ requires prior authorization from Humana with genetic confirmation of Smith-Magenis syndrome (ICD-10: Q93.5) and documented sleep disorder (G47.24). Submit PA requests via fax to 1-877-486-2621 with weight-based dosing calculations and specialist documentation. If denied, you have

How to Get Thiola / Thiola EC (tiopronin) Covered by Aetna (CVS Health) in Washington: Complete PA Guide with Appeal Scripts

Answer Box: Getting Thiola / Thiola EC (tiopronin) Covered by Aetna (CVS Health) in Washington Aetna requires prior authorization for all tiopronin products. To get approval: (1) Confirm cystinuria diagnosis with genetic testing or stone analysis, (2) Document failed conservative therapy (alkalinization, dietary changes), and (3) Submit PA through Availity portal

How to Get Tepezza (teprotumumab) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tepezza Covered by Blue Cross Blue Shield in Washington Fastest path: Submit prior authorization with complete TED documentation (CAS score, photos, euthyroid labs, ophthalmologist prescription). If denied, file internal appeal within plan deadlines, then request IRO external review through Washington's Office of Insurance Commissioner (1-800-562-6900)

How to Get Kalydeco (ivacaftor) Covered by Blue Cross Blue Shield in Washington: Costs, Appeals, and Financial Assistance

Quick Answer: Getting Kalydeco (ivacaftor) Covered in Washington Blue Cross Blue Shield (BCBS) plans in Washington require prior authorization for Kalydeco (ivacaftor) with documented CFTR mutation testing. Most plans place it on specialty tiers (Tier 5-6) with costs ranging from $3,500-$8,950 monthly depending on your coverage. First

How to Get Vyndaqel/Vyndamax (Tafamidis) Covered by Humana in Washington: Complete Decision Tree & Appeals Guide

Answer Box: Your Path to Vyndaqel/Vyndamax Coverage Getting Vyndaqel/Vyndamax (tafamidis) covered by Humana in Washington requires prior authorization with confirmed ATTR-CM diagnosis and cardiology oversight. Start by ensuring your cardiologist has documented evidence of transthyretin amyloid cardiomyopathy (PYP scan Grade 2/3 with negative monoclonal protein screen, or

Work With Your Doctor to Get Taltz (Ixekizumab) Approved by UnitedHealthcare in Washington: Complete Guide

Answer Box: Getting Taltz Approved by UnitedHealthcare in Washington Eligibility: Taltz (ixekizumab) requires prior authorization from UnitedHealthcare for moderate-to-severe plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis. Most plans require step therapy with preferred biologics first. Fastest Path: 1) Complete TB screening and gather PASI scores/functional assessments, 2) Document failure

How to Get Alecensa (Alectinib) Covered by Aetna CVS Health in Washington: Complete PA Guide & Appeal Scripts

Answer Box: Getting Alecensa Covered by Aetna CVS Health in Washington Alecensa (alectinib) is covered by Aetna CVS Health as a Tier 4 specialty medication with mandatory prior authorization. To get approved in Washington: 1. Confirm ALK-positive status with FDA-approved testing results 2. Submit CVS Specialty enrollment form with complete

Work With Your Doctor to Get Exondys 51 (Eteplirsen) Covered by Cigna in Washington: Complete Guide

Answer Box: Getting Exondys 51 Covered by Cigna in Washington What you need: Genetic testing confirming DMD with exon 51-amenable mutation, neurologist prescription, functional assessments (6-minute walk test), and cardiac/pulmonary baseline testing. Fastest path: 1) Schedule visit with neuromuscular specialist, 2) Gather genetic reports and functional testing, 3) Submit

How to Get Vimizim (Elosulfase Alfa) Covered by Cigna in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Vimizim Covered by Cigna in Washington To get Vimizim (elosulfase alfa) covered by Cigna in Washington, you'll need prior authorization with specific documentation: confirmed MPS IVA diagnosis (enzyme or genetic testing), prescription from a geneticist or metabolic specialist, baseline 6-minute walk test, and age ≥5