Topic

Washington

A collection of 489 issues

Getting Signifor LAR (Pasireotide) Covered by Blue Cross Blue Shield in Washington: Complete 2025 Coding, Prior Auth & Appeals Guide

Answer Box: Quick Path to Coverage To get Signifor LAR covered by Blue Cross Blue Shield in Washington: First, identify your specific carrier (Premera Blue Cross or Regence BlueShield). Submit prior authorization using ICD-10 code E24.0 (Cushing's disease) or E22.0 (acromegaly), HCPCS J2502 for billing, and

Work With Your Doctor to Get Defitelio (defibrotide) Approved by Blue Cross Blue Shield in Washington: Complete Prior Authorization Guide

Quick Answer: Defitelio (defibrotide) requires prior authorization from Blue Cross Blue Shield plans in Washington for hepatic VOD/SOS with organ dysfunction after HSCT. Success depends on partnering with your transplant team to document HSCT details, organ dysfunction, and meeting diagnostic criteria. Start by requesting your plan's Defitelio

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

Answer Box: Getting Qinlock Covered in Washington Blue Cross Blue Shield requires prior authorization for Qinlock (ripretinib) for fourth-line GIST treatment in Washington. To get approved: (1) Confirm your specific Blue plan (Premera, Regence BlueShield, or other), (2) Submit complete prior authorization through your oncologist with documented failure of three

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

Quick Answer: Getting Opdivo Covered by Cigna in Washington Cigna requires prior authorization for Opdivo (nivolumab) with specific medical necessity criteria. Your fastest path: Have your oncologist submit a complete PA request through CoverMyMeds or Cigna's provider portal including diagnosis, staging, biomarker results, and prior treatment history. If

How to Get Lutathera (Lutetium Lu-177 Dotatate) Covered by Aetna CVS Health in Washington: Complete Prior Authorization Guide

Answer Box: Getting Lutathera Covered by Aetna CVS Health in Washington Lutathera (lutetium Lu-177 dotatate) requires prior authorization from Aetna CVS Health. The fastest path to approval: 1) Verify your plan's formulary status and PA requirements through the Aetna member portal, 2) Submit a complete PA request with

How to Get Tremfya (guselkumab) Covered by Aetna in Washington: Appeals Guide with State Protections

Answer Box: Getting Tremfya (guselkumab) Covered by Aetna in Washington Fastest path to approval: Submit Aetna's prior authorization form with specialist documentation of diagnosis severity, prior treatment failures, and medical necessity. If denied, use Washington's internal appeal (180 days) followed by independent review organization (IRO) process

How to Get Fabrazyme (agalsidase beta) Covered by Aetna in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Fabrazyme (agalsidase beta) requires prior authorization from Aetna in Washington. Your fastest path: 1) Have your specialist complete Aetna's PA form with genetic testing results and organ involvement documentation, 2) Submit via provider portal or fax, and 3) If denied, file internal appeal within 60-180 days,

Requirements Checklist to Get Kesimpta (Ofatumumab) Covered by UnitedHealthcare in Washington: Forms, Appeals & Timelines

Quick Answer: Getting Kesimpta Covered by UnitedHealthcare in Washington Eligibility: Adults with relapsing MS (RRMS, CIS, active SPMS) who need prior authorization through OptumRx. Fastest path: Submit complete PA with documented step therapy failures or contraindications. Start today: Call UnitedHealthcare at the number on your card to verify Kesimpta'

How to Get Givlaari (Givosiran) Covered by Aetna CVS Health in Washington: Complete Forms, Appeals Guide & Contact Numbers

Quick Answer: Getting Givlaari (Givosiran) Covered by Aetna CVS Health in Washington Path to approval: Submit Aetna's Givlaari precertification form with biochemical confirmation (elevated ALA/PBG levels), documented attack history (≥2 qualifying attacks in 6-12 months), and specialist evaluation. If denied, file internal appeal within 180 days, then

How to Get Amondys 45 (casimersen) Covered by Cigna in Washington: Complete Forms, Appeals & Genetic Testing Guide

Quick Answer: Getting Amondys 45 (casimersen) Covered by Cigna in Washington Eligibility: Cigna covers Amondys 45 for DMD patients with confirmed exon 45-amenable mutations through prior authorization. Fastest path: Have your neuromuscular specialist submit genetic test results plus clinical documentation to Cigna's specialty pharmacy team. Start today: Call