Topic

Washington

A collection of 489 issues

How to Get Sumavel DosePro Covered by Humana in Washington: Complete Appeal Guide with Templates

Quick Answer: Humana typically requires step therapy through oral triptans before covering Sumavel DosePro (sumatriptan injection). In Washington, you have 65 days to file a Medicare Advantage appeal or 60 days for commercial plans. Start by having your doctor document failed oral triptan trials and submit a detailed prior authorization

How to Get Imbruvica (ibrutinib) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization & Appeal Guide

Answer Box: Getting Imbruvica Covered by Blue Cross Blue Shield in Washington Blue Cross Blue Shield plans in Washington (Premera, Regence) require prior authorization for Imbruvica (ibrutinib) with specific renewal criteria including no disease progression and continued monitoring commitment. Your fastest path to approval: have your oncologist submit urgent PA

Myths vs. Facts: Getting Xyrem (Sodium Oxybate) Covered by Blue Cross Blue Shield in Washington

Answer Box: Getting Xyrem Covered by Blue Cross Blue Shield in Washington Blue Cross Blue Shield plans in Washington (Premera, Regence/UMP) almost always require prior authorization for Xyrem (sodium oxybate) for narcolepsy. Success depends on complete REMS enrollment, documented narcolepsy diagnosis with sleep studies, and proof of failed stimulant

Resources to Get Krystexxa (Pegloticase) Approved with UnitedHealthcare in Washington: Complete Forms, Portals & Contact Directory

Answer Box: Getting Krystexxa Covered by UnitedHealthcare in Washington Krystexxa (pegloticase) requires prior authorization through OptumRx for UnitedHealthcare plans in Washington. Submit via the UnitedHealthcare Provider Portal with documented failure of xanthine oxidase inhibitors (allopurinol ≥300mg daily, febuxostat), persistent serum uric acid >6 mg/dL, G6PD testing, and rheumatologist

How to Get Poteligeo (mogamulizumab-kpkc) Approved by Aetna CVS Health in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Poteligeo Covered in Washington Poteligeo (mogamulizumab-kpkc) requires prior authorization from Aetna CVS Health for relapsed/refractory mycosis fungoides or Sézary syndrome after ≥1 prior systemic therapy. Your oncologist submits documentation via the Aetna provider portal showing confirmed CTCL diagnosis, prior treatment failures, and medical necessity. If denied,

Getting Revcovi (Elapegademase) Covered by Humana in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Humana Coverage for Revcovi in Washington Humana covers Revcovi (elapegademase) for ADA-SCID under Medicare Advantage and Part D plans, but requires prior authorization with confirmed diagnosis and specialist documentation. In Washington, you have 65 days to appeal denials, with state external review available for medical benefits. First step

How to Get Tagrisso (osimertinib) Covered by Cigna in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tagrisso Covered by Cigna in Washington Cigna covers Tagrisso (osimertinib) for EGFR-mutated NSCLC with prior authorization. First step today: Have your oncologist submit PA through Cigna's provider portal with EGFR mutation test results, staging, and treatment history. Standard decisions take 72 hours; expedited reviews 24

How to Get Revlimid (lenalidomide) Covered by Blue Cross Blue Shield in Washington: Complete Forms & Appeals Guide

Answer Box: Getting Revlimid (lenalidomide) Covered by Blue Cross Blue Shield in Washington Revlimid (lenalidomide) requires prior authorization from Blue Cross Blue Shield plans in Washington. The fastest path to approval: (1) Verify your plan covers lenalidomide (generic may be preferred over brand Revlimid), (2) Submit PA request through your

How to Get Givlaari (givosiran) Covered by Humana in Washington: Complete Appeals Guide with Templates

Answer Box: Quick Path to Givlaari Coverage Humana requires prior authorization for Givlaari (givosiran) in Washington. You'll need: confirmed acute hepatic porphyria (AHP) diagnosis with elevated ALA/PBG labs, ≥2 attacks in past 6 months, specialist prescriber, and documented hemin use/failure. First step today: Call Humana member

How to Get Zokinvy (lonafarnib) Covered by UnitedHealthcare in Washington: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Zokinvy Coverage in Washington UnitedHealthcare requires prior authorization for Zokinvy (lonafarnib) with specific criteria: confirmed HGPS or processing-deficient progeroid laminopathy diagnosis, age ≥12 months, BSA ≥0.39 m², and genetic testing confirmation. The fastest path: submit complete documentation including genetic test results and specialist consultation through UnitedHealthcare&