Topic

Washington

A collection of 489 issues

Getting Imbruvica (Ibrutinib) Covered by Humana in Washington: Coding, Prior Authorization, and Appeals Guide

Answer Box: Getting Imbruvica (Ibrutinib) Covered by Humana in Washington Humana Medicare Advantage requires prior authorization for Imbruvica (ibrutinib) with step therapy preferences for acalabrutinib or zanubrutinib first. To get approved: (1) Your oncologist submits a PA request via Humana's provider portal with proper ICD-10 codes (C91.10-C91.

How to Get Opdivo (Nivolumab) Covered by Aetna (CVS Health) in Washington: Complete Prior Authorization Guide

Answer Box: Getting Opdivo Covered by Aetna (CVS Health) in Washington Opdivo (nivolumab) requires prior authorization from Aetna (CVS Health) for all oncology indications in Washington. The fastest path to approval: 1) Verify if your plan uses medical or specialty pharmacy benefit, 2) Complete the Opdivo Injectable Medication Precertification Request

Renewing Onpattro (Patisiran) Coverage with Humana in Washington: Complete Timeline & Documentation Guide

Answer Box: Renewing Onpattro (Patisiran) with Humana in Washington Start your renewal process 4-6 weeks before your current authorization expires. Humana typically requires updated mNIS+7 scores, 6-minute walk test results, and neurologist documentation showing stabilization or improvement versus baseline. Submit via Humana's provider portal with complete clinical

Renewing Kuvan (Sapropterin) Approval with UnitedHealthcare in Washington: 2025 Requirements & Timeline

Answer Box: Kuvan Renewal Requirements UnitedHealthcare requires annual prior authorization renewal for Kuvan (sapropterin) with specific documentation: active phenylalanine-restricted diet, sustained blood Phe reduction from baseline (typically ≥20-30%), and confirmation you're not using concurrent Palynziq therapy. Start renewal 60-90 days before expiration. Submit through the UnitedHealthcare Provider Portal

How to Get Waylivra (Volanesorsen) Covered by UnitedHealthcare in Washington: Appeals, Forms & State Protections

Answer Box: Getting Waylivra Covered by UnitedHealthcare in Washington Waylivra (volanesorsen) is typically non-formulary on UnitedHealthcare plans, requiring an individualized coverage exception. In Washington, you have strong appeal rights including independent external review after internal denials. Fastest path: Submit a detailed prior authorization request with genetic FCS confirmation, documented treatment

Renewing Haegarda (C1-Esterase Inhibitor) Approval with Blue Cross Blue Shield in Washington: Timeline, Forms & Appeal Process

Answer Box: Renewing Haegarda with Blue Cross Blue Shield in Washington Blue Cross Blue Shield plans in Washington require annual renewal for Haegarda (C1-esterase inhibitor) with documentation of continued HAE diagnosis and clinical benefit. Start your renewal 60-90 days before expiration by submitting updated attack logs, specialist notes showing reduced

If Tavneos (Avacopan) Isn't Approved by Cigna in Washington: Formulary Alternatives and Exception Strategies

Answer Box: Quick Start Guide If Cigna denies Tavneos (avacopan) for ANCA-associated vasculitis in Washington, you have three main paths forward: 1) Try formulary alternatives like rituximab or cyclophosphamide that may have easier approval, 2) Request a formulary exception with strong clinical evidence showing why alternatives are inadequate, or 3)

A Realistic Jynarque (Tolvaptan) Approval Scenario with Cigna in Washington (From Request to Yes)

Quick Answer: Getting Jynarque (Tolvaptan) Covered by Cigna in Washington Path to approval: Submit Cigna prior authorization with documented rapid ADPKD progression (Mayo class 1C-1E or eGFR decline ≥3 mL/min/1.73m²/year), baseline labs, and REMS enrollment. If denied, file internal appeal within 180 days, then external review

How to Get Kineret (anakinra) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization Guide

Answer Box: Getting Kineret Covered by Blue Cross Blue Shield in Washington Blue Cross Blue Shield plans in Washington (Premera Blue Cross and Regence BlueShield) require prior authorization for Kineret (anakinra). Success depends on documenting failed conventional DMARDs for rheumatoid arthritis or confirmed NOMID diagnosis. If denied, Washington's

How to Get Onpattro (patisiran) Covered by Aetna CVS Health in Washington: Complete Prior Authorization and Appeal Guide

Answer Box: Your Fastest Path to Onpattro Coverage To get Onpattro (patisiran) covered by Aetna CVS Health in Washington: Submit the Onpattro precertification form with genetic testing confirming hATTR-PN, baseline mNIS+7 scores, and neurologist evaluation. Aetna typically decides within 5-10 business days. If denied, file internal appeal within 180