Topic

Washington

A collection of 407 issues

How to Get Cabometyx (Cabozantinib) Covered by UnitedHealthcare in Washington: Complete PA Guide with ICD-10 Codes and Appeals

Answer Box: Getting Cabometyx Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization (PA) for Cabometyx (cabozantinib tablets) through OptumRx for all FDA-approved cancer indications in Washington. Submit PA with confirmed diagnosis (ICD-10: C64 for RCC, C22.0 for HCC), prior therapy documentation, and RECIST imaging showing progression. If denied,
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How to Get Givlaari (Givosiran) Covered by UnitedHealthcare in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Givlaari Covered by UnitedHealthcare in Washington Givlaari (givosiran) requires prior authorization from UnitedHealthcare OptumRx, with potential step therapy requirements. Washington state law (RCW 48.43.420) provides strong protections for step therapy exceptions when medically necessary. First step: Have your specialist submit a prior authorization request with
6 min read

How to Get Amvuttra (Vutrisiran) Covered by UnitedHealthcare in Washington: Complete Guide to Prior Authorization, Appeals, and External Review

Answer Box: Getting Amvuttra Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Amvuttra (vutrisiran) in Washington. Submit documentation including TTR genetic testing, specialist evaluation, and baseline outcomes via OptumRx PreCheck Prior Authorization or call 1-800-711-4555. If denied, appeal within 65 days internally, then request external review through Washington&
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Work With Your Doctor to Get Kuvan (Sapropterin) Approved by Blue Cross Blue Shield in Washington: Complete Prior Authorization Guide

Answer Box: Getting Kuvan Covered in Washington Kuvan (sapropterin dihydrochloride) requires prior authorization from Premera Blue Cross in Washington for PKU treatment. Success depends on strong provider collaboration documenting: confirmed PKU diagnosis, elevated phenylalanine levels despite dietary management, and BH4 responsiveness testing showing ≥30% phenylalanine reduction. Fastest path: Schedule a
5 min read

How to Get Besponsa (Inotuzumab Ozogamicin) Covered by Aetna CVS Health in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Besponsa Covered by Aetna CVS Health in Washington Aetna CVS Health requires prior authorization for Besponsa (inotuzumab ozogamicin) in Washington. Coverage is approved for CD22-positive B-cell precursor ALL (relapsed/refractory) with documented prior therapy failures. Fastest path: Your oncologist submits the Aetna Besponsa precertification form with CD22+
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How to Get Stelara (Ustekinumab) Covered by UnitedHealthcare in Washington: Complete Guide to Prior Authorization, Appeals, and Medical Necessity Letters

Answer Box: Your Path to Stelara Coverage in Washington UnitedHealthcare requires prior authorization for brand Stelara (ustekinumab) with step therapy through biosimilars first. In Washington, if denied, you have 180 days for internal appeals plus external review through an Independent Review Organization. Start today: Have your doctor submit a medical
6 min read

How to Get Pomalyst (pomalidomide) Covered by Aetna (CVS Health) in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Pomalyst (pomalidomide) Covered by Aetna (CVS Health) in Washington Aetna (CVS Health) requires prior authorization for Pomalyst (pomalidomide) with documented failure of both lenalidomide and a proteasome inhibitor, plus PS-Pomalidomide REMS enrollment. Submit PA within 24-48 hours of REMS completion via Aetna's provider portal with
7 min read