Topic

Washington

A collection of 489 issues

How to Get Orkambi (lumacaftor/ivacaftor) Covered by UnitedHealthcare in Washington: Prior Authorization, Appeals, and Coding Guide

Answer Box: Getting Orkambi Covered in Washington UnitedHealthcare requires prior authorization for Orkambi (lumacaftor/ivacaftor) based on confirmed cystic fibrosis diagnosis, homozygous F508del CFTR mutation documentation, and prescription by a CF specialist. Submit through OptumRx with genetic lab results, ICD-10 E84.0-E84.9, and clinical notes. If denied, Washington residents
6 min read

How to Get Gattex (Teduglutide) Covered by Humana in Washington: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Gattex (Teduglutide) Covered by Humana in Washington Humana requires prior authorization (PA) for Gattex (teduglutide) for short bowel syndrome with parenteral nutrition dependence. Your gastroenterologist submits PA electronically via Humana's provider portal with documented SBS diagnosis, 12+ months of PN logs, recent colonoscopy, and failed
7 min read

Getting Qalsody (Tofersen) Approved by UnitedHealthcare in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Qalsody Coverage UnitedHealthcare covers Qalsody (tofersen) for ALS patients with confirmed SOD1 mutations, but requires prior authorization with specific documentation. First step: Have your neurologist gather your genetic test showing pathogenic SOD1 mutation, baseline ALSFRS-R score, and ALS diagnosis notes. Submit through UnitedHealthcare's
6 min read

How to Get Orladeyo (berotralstat) Covered by UnitedHealthcare in Washington: Complete Guide to Forms, Appeals, and Timelines

Answer Box: Getting Orladeyo Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Orladeyo (berotralstat) with documented HAE diagnosis, step therapy completion, and specialty pharmacy dispensing. Submit PA via UnitedHealthcare Provider Portal or fax to 1-844-403-1027 within 24-72 hours for electronic requests. If denied, file internal appeals within 180
5 min read

How to Get Busulfex (Busulfan Injection) Covered by Cigna in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Busulfex (busulfan injection) typically requires prior authorization from Cigna in Washington, billed under medical benefit with HCPCS J0594. Submit PA through Cigna provider portal or EviCore with complete conditioning regimen details, diagnosis codes, and medical necessity letter. If denied, file internal appeal within 180 days, then request external
6 min read

How to Get Exondys 51 (eteplirsen) Covered by Aetna (CVS Health) in Washington: Appeals, Timelines & Templates

Answer Box: Your Fastest Path to Approval Getting Exondys 51 (eteplirsen) covered by Aetna (CVS Health) in Washington requires genetic testing proving exon 51-amenable DMD mutation, specialist prescriber, and functional documentation. Submit prior authorization with complete genetic report, 6-minute walk test results, and neuromuscular specialist letter. If denied, Washington law
7 min read

How to Get Orladeyo (berotralstat) Covered by Blue Cross Blue Shield in Washington: Prior Authorization, Appeals, and Cost Assistance Guide

Answer Box: Getting Orladeyo Covered by Blue Cross Blue Shield in Washington Orladeyo (berotralstat) requires prior authorization from Blue Cross Blue Shield plans in Washington, with coverage typically requiring confirmed HAE diagnosis, age ≥12 years, and prophylaxis indication. Your fastest path to approval: 1. Gather documentation: HAE diagnosis with C1-INH/
5 min read

How to Get Sumavel DosePro (Sumatriptan Injection, Needle-Free) Covered by UnitedHealthcare in Washington: Prior Authorization Guide, Appeals Process, and State Protection Rights

Answer Box: Fast Track to Approval Sumavel DosePro (needle-free sumatriptan injection) is discontinued but generic auto-injectors require UnitedHealthcare prior authorization with step therapy to oral triptans first. Washington residents have strong appeal rights through Independent Review Organizations (IROs) after internal denials. Start today: (1) Request step therapy exception if oral
7 min read

How to Get Xywav Covered by UnitedHealthcare in Washington: Complete PA Guide & Appeal Steps

Answer Box: Getting Xywav Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Xywav (calcium-magnesium-potassium-sodium oxybates) with specific medical documentation and REMS enrollment. The fastest path: (1) Complete REMS enrollment at XYWAVXYREMREMS.com, (2) Submit PA via UHC provider portal with sleep study results and prior therapy documentation, (3)
6 min read